Oral Answers to Questions

FOREIGN AND COMMONWEALTH AFFAIRS

The Secretary of State was asked—

Burma

Julie Morgan: What steps he is taking to help restore democracy in Burma.

Ian Pearson: The Government are working closely with our European and international partners to promote political reform in Burma. We have consistently made it clear to the regime that it must release Aung San Suu Kyi and other political prisoners as a first step to restoring democracy.

Julie Morgan: I thank the Minister for his reply. In view of the continuing human rights violations, the drug trafficking, the outflow of refugees and the continuing house arrest of Aung San Suu Kyi, what can he do to work towards a binding resolution by the United Nations Security Council to ensure democracy in Burma? Members of the National League for Democracy are being imprisoned and harassed. Is there not something more that he could do to get a resolution at the Security Council?

Ian Pearson: My hon. Friend is right to point to the human rights abuses that are going on daily in Burma. She will be aware that the UN Security Council met on 16 December and that Burma was discussed at that meeting. At present, there is no consensus within the Security Council even to put Burma on the agenda, let alone to secure a resolution, but I assure her of the Government's commitment to do all that they can to press for further progress. I am pleased to be able to note the progress that has been made through some of our lobbying efforts with the Association of South East Asian Nations. She will be aware perhaps that, just before Christmas, ASEAN put out a statement. The fact that ASEAN is showing concern about the political situation in Burma and is perhaps prepared to do something about it is welcome.

Bob Spink: Will the Minister pay tribute to the Thai Government for their actions and help for internally displaced people from Burma? Will he press the Thai Government to go further and to issue identification documents to all those displaced people from Burma?

Ian Pearson: My right hon. Friend the Foreign Secretary met the Thai Deputy Prime Minister last week. We certainly acknowledge the work of the Thai Government in making a welcome home for those fleeing from persecution in Burma. The Foreign Office has a project working with the Thai authorities to assist in that process. It is a difficult issue. More and more people are fleeing the country because of the despicable nature of the regime, but I assure the hon. Gentleman that we will take what appropriate action we can to help the situation.

Vera Baird: I have every reason to believe that ASEAN's move was largely due to pressure from the British Government. I compliment my hon. Friend on that. May I ask him about the EU common position on Burma, which I am sure he agrees is one of low impact—arguably, of no impact? The sanctions against the regime are patchy, weak and of no practical consequence and very little symbolic consequence. We hoped that change would come during the EU presidency, but now the common position is due to be renegotiated. Will he do his level best to ensure that the EU adopts real, significant, biting sanctions against that abysmal regime?

Ian Pearson: I thank my hon. and learned Friend for her words of welcome about the UK's lobbying efforts. Not just the UK but many other countries have been talking to ASEAN about the need to do more on Burma.
	The EU common position is due for renewal in April this year. We believe that there have been no improvements in the situation in Burma over the past 12 months and therefore there is no case for weakening the sanctions, but let us be clear. Our policy of sanctions is deliberately targeted on the Burma regime and its cronies. We do not believe that economic sanctions that would harm the Burmese people are appropriate. They are already suffering enough as a result of that despicable regime and sanctions that affected their livelihoods would be inappropriate.

Iran

Bill Wiggin: What assessment he has made of Iran's support for terrorist groups; and if he will make a statement.

Jack Straw: We remain very concerned about Iran's approach to terrorism and the nature of its relationship with Lebanese Hezbollah and Palestinian Islamic Jihad. We also continue to investigate Iran's links to extremist groups in Iraq. We have repeatedly pressed Iran to renounce all support for groups using terror and violence. I raise these concerns whenever I have the opportunity to do so, most recently in my meeting with the Iranian Foreign Minister in London last week.
	There are of course even wider anxieties about Iran's current behaviour, above all in respect of its nuclear programme. Last Saturday, the International Atomic Energy Agency's board of governors decided to report Iran to the Security Council for non-compliance with its obligations but to allow a further month before any action was to be taken by the Council. That resolution attracted wide support, including from Russia, China, India, Egypt, Brazil, Sri Lanka and Yemen, which I hope will underline to the Iranian leadership the strength of feeling internationally on this matter and encourage them to take the opportunities offered by the resolution.

Bill Wiggin: What assessment has the Foreign Secretary made of Iran's support for terrorist insurgency groups in Afghanistan's Helmand province?

Jack Straw: I have seen no evidence of Iranian support for insurgent groups in that province. As is often the case, Iran's record can vary very much, in apparently contradictory ways. Overall, Iran has worked responsibly in respect of its relations with Afghanistan. Iran has good reason for doing so and suffers grievously from the trade in opium; it has been suggested that there are more than 2 million heroin addicts in Iran, fuelled by drugs from Afghanistan. For the time being, on the issue of drugs and in its relationships with Afghanistan, Iran's interests are the same as ours. However, in respect of other terrorist groups to the west of the country, the picture is a different one.

Andrew MacKinlay: Will the Foreign Secretary take this opportunity to reaffirm the United Kingdom's support for the Iranian resistance people in Camp Ashraf in Iraq, bearing in mind that they have protected person status under the Geneva conventions? Will he confirm that he will resist any attempt by the Iranian Government to make the coalition or the United Kingdom falter upon that commitment?

Jack Straw: I am sorry to disappoint my hon. Friend but the answer is an emphatic no. The MEK/MKO organisation is a terrorist organisation that is proscribed in this country following a decision that I made as Home Secretary in 2000, which was endorsed by Parliament. We have a consistent position on terrorist organisations. As I repeatedly make clear to my Iranian counterparts, it is they who have a contradictory position. They ask us to take a firm position in respect of terrorist groups that threaten Iran, and we do; at the same time, Iran is supporting terrorist organisations that threaten Israel. That is unacceptable.

Brian Binley: On the basis of his answer, will the Foreign Secretary give examples of where the People's Mojahedin Organisation of Iran and its allied bodies have taken any terrorist action against western interests in actual terms?

Jack Straw: I would need notice of that question. However, like any other organisation similarly proscribed, the MEK/MKO has had every opportunity to make strong representations to the Proscribed Organisations Appeal Commission. As it was subsequent to my leaving the Home Office, I cannot remember whether it has done so. If it has, its objections have been overruled. The decision was made by this House on the basis of my recommendation, endorsed by my successors.

Denis MacShane: Iran supports terrorism, wants to see the extermination of every Jew from the face of the earth in its region and soon will possess a nuclear bomb. My right hon. Friend has tried with might and main to find a diplomatic solution, but we are on a glide path to a serious confrontation. In that regard, 35 years ago the main enemy of the United States—it had an ideology that America opposed and supported action that America opposed—was China but, in a great diplomatic coup, President Nixon went to China, recognised China and world history was turned. Does my right hon. Friend think that the time has come for the United States to offer diplomatic recognition to Iran—a personal opinion, please?

Mr. Speaker: Order. I hope that the Foreign Secretary will be more brief than the questioner.

Jack Straw: I think that that is a matter for the United States, Mr. Speaker.

Nicholas Clegg: In considering what a long-term solution might be to the relationship between the outside world and Iran, does the Foreign Secretary believe that there is a case for some form of security assurance for Iran? Of course, such an assurance was one component in the draft agreement between the United States and North Korea in September 2005. If he does believe that, can he confirm what reflections the EU3 have made on what such a security assurance might look like, and what discussions he has had with his opposite numbers in Washington on that point?

Jack Straw: On the first question, yes, I do, and what is frustrating, to say the least, is that security assurances—I point out to my right hon. Friend the Member for Rotherham (Mr. MacShane) that they could have led, over time, to a normalisation of relations with the whole of the international community, including the United States—and all other such issues were on the agenda following the decisions and agreements that we reached in Geneva at the end of last May. They were included in the detailed document that we submitted to the Iranians, on time, in early August, but, infuriatingly, the Iranian Government decided on 2 August to reject whatever we said before they even saw it. That is the cause of the current difficulties.

William Hague: Will the Foreign Secretary accept the Opposition's strong support for the work that has been done to achieve a united position among the permanent members of the UN Security Council, including China and Russia, on reporting Iran to the Security Council? In the event that Iran does decide to reconsider Russia's nuclear proposal in the coming weeks, is the Foreign Secretary confident that that scheme, which the British Government have endorsed, will be robust enough to prevent Iran from pursuing a covert nuclear weapons programme while appearing to co-operate with Russia?

Jack Straw: First, I thank the right hon. Gentleman for his endorsement of our work; the fact that there is broad all-party consensus on this issue helps our hand when we negotiate within the EU3 and with international colleagues. Our being able to get agreement last Monday from Russia and China on the next and most difficult step—a report to the Security Council—has been very important. As I said earlier, I hope that that gives the Iranian leadership pause for thought.
	The Russians have made it clear that their proposal, by which they would enrich uranium, is not an addition to uranium being enriched at the Natanz operation in Iran but an alternative to it. If that happens, and the IAEA is able to continue with the kind of inspection regime that the additional protocol provides for, I believe that we could be pretty certain that Iran was not doing anything of a covert nature. But in the absence of those two conditions, it is very difficult to accept such a move.

William Hague: If Iran does not pursue the Russian offer, how does the Foreign Secretary see the situation developing in Security Council discussions over the next few months? Will it be possible, for instance, to propose an end to all exports of military technology and hardware from other countries to Iran, and to achieve such a position in the coming months? If it will not, what genuine hope is there of applying real and concerted pressure on the Iranian Government in the future?

Jack Straw: First, we hope that the Iranian leadership—notwithstanding their rhetoric, which has been extreme—will think carefully in the next three to four weeks about where they are taking their country, because if they take this path they are heading toward international isolation, which is not the direction in which they ought to be travelling.
	Secondly, if we end up with a report to the Security Council and its considering the matter, the first stage will be a Security Council resolution exerting its authority in support of IAEA processes. There are people who say, "If you do that and nothing else, you won't be able to achieve anything." I do not agree with that. We can see from the experience with Syria in the past 18 months that although international pressure and the authority of the Security Council—without sanctions—has not achieved everything, it has achieved a great deal. But if those steps fail, extensive discussions will have to take place with our partners on whether article 41 measures would be appropriate. The right hon. Gentleman will excuse me if I do not anticipate those, but I make the obvious point that what we can agree in the Security Council will depend above all on the consensus that we can secure among the permanent five members.

Cuba

Jeremy Corbyn: What recent discussions he has had with the US State Department on relations with Cuba.

Douglas Alexander: Ministers have not had recent meetings with the US State Department about Cuba. However, official-level meetings, in which there are candid exchanges of views, have covered Cuba. We share US concerns about the deteriorating human rights situation in Cuba. But, while the US favours sanctions and isolation, our—and European Union—policy is for constructive engagement with the Cuban authorities and civil society, including on human rights.

Jeremy Corbyn: Can my hon. Friend confirm that in November last year officials from his Department entertained Mr. Caleb McCarry, who is the head of the State Department unit that is designed to undermine the independent Government of Cuba? Can he confirm that it is the British Government's policy not to undermine Cuba, but to work with and respect Cuban sovereignty and independence? Many Back Benchers are concerned about the policy, so will he—and my right hon. Friend the Foreign Secretary—agree to meet a delegation so that our views can be aired in detail?

Douglas Alexander: Our long-standing policy, and that of the European Union, is one of constructive engagement in pursuit of a peaceful transition to a pluralist democracy on the island of Cuba. I can confirm that a meeting took place with Mr. Caleb McCarry, as the US-Cuba transition co-ordinator. That meeting took place on 7 November 2005, when the individual was on his way to a conference in Brussels where he met many European partners. It is entirely normal for Foreign Office officials to meet equivalent officials in the US State Department to discuss matters of mutual interest. On my hon. Friend's final point, I will pass on his representations to the Minister with direct responsibility for Cuba and ask that such a meeting be facilitated.

Michael Gove: The Minister will be aware that the European Parliament recently awarded its Sakharov prize to the Women in White, a Cuban human rights organisation that has campaigned for the freedom of political prisoners still held captive in that Marxist holdout in the Caribbean—[Hon. Members: "Hear, hear!"] Given the strength of feeling on these Benches, will the Minister meet a delegation of those of us who believe in democracy, pluralism and freedom in Latin America? Will he agree that the best thing that the Government could do is to emulate what the Thatcher Government did to Andrei Sakharov and make heroes and examples of those who have struggled for freedom in Cuba, and ensure that pressure is applied to guarantee political prisoners the freedom that they—[Interruption.]

Douglas Alexander: I did not manage to hear the entire question, but I got the point. The authentic voice of the Henry Jackson Society has been heard in the Chamber this afternoon. I fear that Lord Triesman will have a busy diary after my appearance at the Dispatch Box today. I am certainly happy to pass on the hon. Gentleman's representations.

Douglas Hogg: Will the Minister cause his officials to say to the US Administration that they would be better placed to lecture Cuba on human rights if they were to ensure that the detainees in the Guantanamo Bay base had the same rights that they would have if they were held in the US?

Douglas Alexander: I assure the House that the US Government have been informed at all levels of our differences of opinion about the detainees at Guantanamo.

Afghanistan

Nick Hurd: If he will make a statement on opium production in Afghanistan.

Kim Howells: Last year saw a 21 per cent. reduction in the area of opium cultivation in Afghanistan. But, as President Karzai said at the London conference last week, narcotics along with terrorism are the gravest threats facing Afghanistan. That is why we support Afghanistan's national drug control strategy and why we must work with the Afghan Government to combat the narcotics trade at every level. The strategy recognises the scale and complexity of the challenge, and sets out a clear long-term plan for tackling it.

Nick Hurd: An Afghan farmer earns 150 times more for 1 kg of opium than he does for 7 kg of wheat. Is it not time to wake up to the economics? Instead of continuing to fail by tinkering at the margins of the supply side, would not £50 million of British taxpayers' money be better spent tackling demand for heroin in the UK?

Kim Howells: I very much agree with the hon. Gentleman that we must do much more to tackle demand for heroin, just as we have to try to help the Government in Colombia by tackling the demand for cocaine in this country. However, the approach must be multifaceted. We should not just be trying to address the demand; we must also take down the drugs mafia in Afghanistan, which supplies not only the UK but millions of heroin addicts in Pakistan and Iran. The industry is very market-responsive and we have to recognise that fact and try to help the Afghans to overcome it in whatever way we can.

Paul Flynn: A 20 per cent. decrease in the area cultivated but only a 2 per cent. decrease in the amount of heroin produced: are we not on mission impossible, sending troops into the Helmand province, and will that not result, perversely, in an increase of violence that drives local farmers into the hands of the Taliban? Are not our present policies leading to the Colombianisation of large parts of central Asia?

Kim Howells: No, but with respect to my hon. Friend, his policies would lead that way. It is not enough to assume that if people eat the right kind of muesli, go to first nights of Harold Pinter revivals—[Hon. Members: "More, more."]—and read The Independent occasionally, the drug barons of Afghanistan will go away. They will not. The poison that is being pumped into the veins of children in the UK is coming from Afghanistan and we must play our part to stop that happening.

Julian Lewis: It is wonderful to have such a politically incorrect Minister at the Dispatch Box, but does the hon. Gentleman remember his written answers to my hon. Friend the Member for Forest of Dean (Mr. Harper), published only yesterday? The Minister conceded that the vast majority of Afghan warlords had been against the Taliban regime, but that he does not know what proportion of Afghan warlords who are against the regime are involved in the drugs trade. Does he not realise that there is a danger of a mixed mission, with the serious possibility that what the hon. Member for Newport, West (Paul Flynn) said will come true? Troops intervening to stop the drugs trade may actually consolidate warlords behind the Taliban. That is a serious risk.

Kim Howells: I realise what the hon. Gentleman is saying and I heard what my hon. Friend the Member for Newport, West (Paul Flynn) said, but I do not agree with either of them. There is a risk of that happening—there is no question about that—but we have no choice but to try to take it on. The alternative is not to take any risks whatever in the terrible business of opium growing and heroin exporting. The hon. Gentleman may feel that the subject should be left to divine intervention. I do not agree, and I do not agree with my hon. Friend either. It is absolutely vital that we take appropriate action. We have thought long and hard, and we believe that our action is appropriate.

Chris Mullin: Is my hon. Friend aware that yesterday I entertained four Afghan farmers in the House of Commons? Two of them came from villages that had been aerially sprayed and they told me that the spraying was indiscriminate; it had destroyed their wheat, vegetables and fruit, and in some cases children had died because they had eaten sprayed fruit. I urge my hon. Friend to pay careful attention to the methods used to carry out the crop eradication process and perhaps to have a slightly more open mind to the alternatives.

Kim Howells: I am not sure which alternatives my hon. Friend is suggesting, as he did not talk about them, but I absolutely agree about aerial spraying. I have seen from the air and on the ground how farmers in Afghanistan grow crops interspersed with opium. Aerial spraying could cause famine, among other things, so we must be careful about it. On the other hand, I am very much in favour of crop eradication where it can be carried out on the ground in properly controlled circumstances.

Gregory Campbell: Criminal gangs across the United Kingdom and paramilitary groups in Northern Ireland are making millions of pounds from the illegal importation of drugs. The disruption of a considerable amount of drugs last week is most welcome, but what assurance can the Minister give to people across the UK that we are taking further steps in conjunction with our EU partners totally to disrupt, in so far as is possible, that illegal and nefarious trade?

Kim Howells: My right hon. Friend the Foreign Secretary referred earlier to the difficulties that have been experienced, for example, with traffickers on the Iranian-Afghan border and the Pakistani-Afghan border. We think that the Iranians may have lost thousands of men over the past 10 years in trying to disrupt the drug convoys out of Afghanistan. Those convoys are heavily armed—they have anti-aircraft missiles—and they are very difficult to stop; but stop them we must, some way or other, and we look for co-operation right along the drugs routes, some of which go through central Asia and Russia, as well as through Turkey and the Balkans. We must build, with diplomacy, an absolute determination right the way along the line to do what we can to disrupt and stop that drugs trafficking, wherever we can.

Diane Abbott: The Minister will be aware that much of the heroin sold on the streets of Hackney and across the inner cities originates in Afghanistan, with all the terrible social consequences. He will also be aware that, horrific though the Taliban regime was, opium production was almost eliminated under the Taliban. [Interruption.] Well, they had gone some way towards that. Does he accept that our policies in Afghanistan will not be deemed a success unless we are successful in interrupting and suppressing the production of opium?

Kim Howells: I certainly agree with the last part of my hon. Friend's question. On my visits to Afghanistan I have looked very hard at the story of how the Taliban stopped heroin production. What I discovered when I was out there is that they were very astute business men. They realised that the price of raw opium was pretty low. They held stocks back for a couple of years; the price shot up, and they released them. I would not look to the Taliban for any kind of moral guidance on what we ought to do about this.

Geoffrey Clifton-Brown: We are receiving breaking news that there has been a serious riot in the town of Maymana in Afghanistan, where 300 demonstrators are rioting and one demonstrator has been shot. Of course, British troops have been called in to support Norwegian and Finnish troops. Into that very difficult situation, we are about to deploy 5,000 more British troops to deal with the opium problem, whereby local people and local farmers are exploited by warlords and others, aided by insurgents coming across an increasingly porous and difficult border from Pakistan and Iran. Precisely how do the British Government think that our troops will deal with the opium problem and how long does the Minister think that they are likely to be deployed?

Kim Howells: The deployment is, of course, phase 3 of the international security assistance force deployment in Afghanistan. As the hon. Gentleman will know, UK troops will be deployed to Helmand in support of the UN-authorised, NATO-led mission—the ISAF—and as part of the international coalition. They will help to create an environment in which economic development and institutional reform, both essential to the elimination of the opium industry, can take place. I am sure that the hon. Gentleman will agree that this is a question not simply of trying to disrupt those who are producing and moving drugs around, but of building capacity in Afghanistan, so that the reach of the democratically elected Government into a province such as Helmand becomes a reality. We must approach this subject in many ways—including economic development, of course—and that is what our troops will do. They will help to underpin all those efforts, which are many and various.

EU Constitution

David Evennett: If he will make a statement on the future of the European Union constitution.

Douglas Alexander: As my right hon. Friend the Prime Minister said in Oxford last Thursday, the key issue now is for the European Union to face practical challenges, such as economic reform and energy security. As he acknowledged on Thursday, the effectiveness of a European Union of 25 is constrained by the current rules, but we judge that now is not the time to make institutional debates the focus of the EU's work.

David Evennett: I thank the Minister for that answer. Now that even the Prime Minister acknowledges that the EU constitution did not address the needs of the citizens, will the Minister confirm that it is dead and will not be implemented by the back door? The British people think that the Government are rather feeble on the issue.

Douglas Alexander: There is little that I can usefully add to the comments of my right hon. Friend the Secretary of State at the Dispatch Box during Foreign Office questions last month, except to say that it is not for any one country to declare the constitutional treaty dead. We are, of course, in the midst of a period of reflection at the moment.

Wayne David: Irrespective of what happens to the European constitution, it is still possible to promote the democratisation of the European Union. Does the Minister have any proposals to enhance the role of national Parliaments in European decision making?

Douglas Alexander: The issue of transparency was one with which we dealt during our presidency, as was subsidiarity. We held a major conference along with the Dutch Government on sharing power in Europe. We must work on the basis of existing treaties, but, none the   less, the British Government continue to work on the issue with other European partners.

William Cash: What is the view of the Minister and the Government on the proposal made by Andrew Duff in the European Parliament on setting up a parliamentary forum, which has apparently been endorsed by President Barroso? In that context, do not the Government have to look at existing treaties, which have been the cause of low growth, high unemployment, the failure of the stability and growth pact, regionalisation and a whole range of policies that are deeply unpopular in the United Kingdom? Will he make arrangements to review those treaties properly?

Douglas Alexander: Mr. Duff has been working as a member of the Constitutional Affairs Committee of the European Parliament and has brought forward proposals based on his own thinking. While we will consider all representations, it would not follow precedent for us to go along with the letter of Mr. Duff's advice on constitutional matters.
	On the hon. Gentleman's more substantive point about what the European Union's priorities should be, I have taken heart from the fact that our agenda for jobs and growth is being advanced not simply by the British Government, but, increasingly, by the European Commission. Indeed, the European Commission President, José Manuel Barroso, was quoted in The Times on 10 January as stating:
	"Please avoid a new division in Europe about institutions. The most important concern now of EU citizens is not institutional problems, but jobs and growth."
	I agree entirely.

David Heathcoat-Amory: Did the Minister note from the remarks of the Prime Minister in Oxford last week that the process of European integration had become self-perpetuating and self-absorbing and that no one knew what the European constitution was designed to solve, which some of us pointed out at the time? Given the Prime Minister's change of heart, will the Minister put a stop to the implementation of the European constitution by other means? As the European Scrutiny Committee finds almost weekly, that option is being pushed by the Commission and augmented by member states, including the British Government.

Douglas Alexander: With unalloyed joy, as usual, I look forward to my appearance before the Committee later this week. On the right hon. Gentleman's substantive point about the implementation of the treaty, the British Government's position is unchanged: the draft constitutional treaty will not be implemented, except by means of a referendum in the United Kingdom.

Gisela Stuart: Does the Minister agree that just as it is futile to try to revive the constitution at the moment, it is equally futile to scan through it to find bits that are worth implementing? The constitution was a package, so if we reject the whole thing, we should not try to revive its parts.

Douglas Alexander: I recently spoke about exactly that issue to a European colleague, who warned me that one country's cherry is another country's lemon. That point is well made in the sense that an aspect of the constitutional treaty that is judged to be perfectly sensible and prosaic in the United Kingdom—the question of transparency, or greater subsidiarity—can be highly contentious in the eyes of the other 24 member states.

Graham Brady: There seems to be some confusion in the UK Government's position on the EU constitution. Last month, the Foreign Secretary told me that it was difficult to argue that the constitution was anything other than dead. This morning, however, the Prime Minister talked about the need to return to the issue and spoke about a reasonably large hurdle that must be overcome if it is to be revived.
	We agree with the Prime Minister that the big issues of energy security, economic decline, illegal immigration and organised crime are the real priorities for the EU, but if we want the other member states to focus on them, is it not now essential that the Government state simply and unambiguously that the EU constitution is dead? Although the Minister says that it is not for one country to say that it is dead and to end it, if he said that Britain would veto it if it came back, the whole thing would be finished and we could concentrate on the real priorities.

Douglas Alexander: I can assure the House that we are concentrating on the real priorities. The priorities set out by the hon. Gentleman were exactly the substance of the meeting that took place in Hampton Court last October; for example, energy security. We used the period of reflection to say that we needed a broader debate about how Europe could engage with some of the challenges that we face in the 21st century, whether climate change, energy security or indeed energy supply diversity. That is why, since Hampton Court, work has been taken forward both by High Representative Javier Solana and by the European Commission.

Keith Vaz: Were not the Foreign Secretary's words that the constitution was not dead but in limbo, somewhere between heaven and hell? On the Prime Minister's speech, although of course we accept that we cannot have a debate on institutions and constitutions in the present circumstance, surely there are practical steps that we can take with our European partners, to ensure that the European Union continues along the reform agenda—practical steps that would be of great benefit to the people of Europe, including those of the United Kingdom.

Douglas Alexander: My hon. Friend is accurate in his reflections on the comments of my right hon. Friend the Foreign Secretary at the last Question Time, when he stated that the constitutional treaty was somewhere between heaven and hell and that it was difficult to argue that it is not dead. He also stated, however, that the document was "in limbo". I will not go into the broader theological discussions as to whether limbo has altered as a result of the latest papal encyclical.
	What I will say is that the practical steps that my hon. Friend urged on me are exactly the steps that the British Government are taking, whether on the issue of a common energy policy, on jobs and growth, where we continue to push the better regulation agenda, or indeed on the wide range of other issues, such as counter-terrorism measures, which it is necessary to look at not solely from the point of view of one nation state but in light of how we can work together effectively in partnership with other European countries.

Ian Paisley: I am sure that the Minister would like to know that people will be greatly alarmed that Europe is in a period of reflection. I assure him that all the reflection in the world is not going to raise the dead; regardless of a certain religious leader who believed in a certain place which has now been abolished, quite evidently the constitution is not going to purgatory, and if it is not in heaven and it is not in hell, it is dead. It would be better for the Minister now to reflect on the price of the funeral and then get a new constitution.

Douglas Alexander: It is intriguing to be offered such advice on Catholic theology by the right hon. Gentleman, but I shall certainly reflect on the points that he has made.

Cyprus

Nigel Waterson: If he will make a statement on his recent visit to Cyprus.

Jack Straw: In Cyprus, I met Foreign Minister Iacovou and the leader of the Turkish Cypriot community, Mr. Talat. I urged the two communities to resume their dialogue, for the longer that settlement negotiations are delayed, the harder a settlement will be to achieve. We also have to ensure that Turkey's EU accession track and the United Nations settlement process are not competing, but are complementary. During my meeting I stressed to all parties, including Turkey and Greece, which I also visited, that the status quo is bad for Cyprus, bad for the region and bad for the EU.
	We have noted all the responses to Foreign Minister Gul's proposals of 24 January, including the positive reactions of EU Comissioner Olli Rehn and the Governments of Italy and Spain. Those proposals are a constructive step and deserve to be taken seriously.

Nigel Waterson: I am grateful to the Foreign Secretary for that reply, but does he think, on balance, that his visit has contributed to an improvement in relations with the Republic of Cyprus and with the Greek Cypriot community here in the UK, or does he agree with President Papadopoulos that his visit has poisoned relations between Nicosia and London?

Jack Straw: I do not accept the latter. It is a matter of great regret and entirely counter-productive that President Papadopoulos decided to object to my visiting Mr. Talat in his offices—the same premises, I may say, where one of my predecessors, the right hon. and learned Member for Kensington and Chelsea (Sir Malcolm Rifkind), visited Mr. Denktash in 1996. It would have been preposterous if I had treated Mr. Talat less well than the right hon. and learned Gentleman treated Mr. Denktash.

Malcolm Rifkind: As the Secretary of State has said, my visit to Rauf Denktash was not in any way objected to by the then President Klerides and was seen as a sensible way of having dialogue with both communities. Will the Secretary of State therefore continue to impress on President Papadopoulos and the Government of the Republic of Cyprus that the best interests of the republic will be served by proper and responsible contact with recognised leaders of the Turkish community?

Jack Straw: I am very grateful to the right hon. and learned Gentleman for his remarks. I hope that it will send a message to the Government of Cyprus that this is not a partisan issue dividing the House but one on which there is a substantial all-party consensus in favour of the two communities—the Greek Cypriots in the south and the Turkish Cypriots in the north—coming together. I take it from what he has said that he, and I believe the House too, also regard it a matter of regret that the Administration of President Papadopoulos have sought to distance themselves from the Turkish Cypriot community and to cease to have any contact with it. Moreover, because of their unhelpful approach towards the aid proposals for the north from the European Union, they are in my judgment seeking to marginalise the Turkish Cypriot community and not in any way to assist in their economic development. That cannot help the Greek Cypriot community any more than it can help the Turkish Cypriot community.

Vincent Cable: What action can the Foreign Secretary take to defend the interests of British citizens, including Mr. Departhog a constituent about whom I have written to him, whose property and homes in northern Cyprus have been expropriated by the military, as the civilian Turkish authorities will not accept representations relating to the behaviour of their military?

Jack Straw: The hon. Gentleman raises another reason why the only salvation for Cyprus is through negotiations leading to a sensible settlement, brokered by the United Nations, and by an end to the division of the island. That is the only way in which the genuine interests of the Greek Cypriot community, including those of Greek Cypriot origin who are British citizens, can be resolved satisfactorily. The issue of compensation for land seized is central to those negotiations. Unless and until the Greek Cypriot Government, as well as the Turkish Cypriots and others with interest, get back to the negotiating table, there is in practice absolutely no chance of the hon. Gentleman's constituent receiving what is due to him. I wish it were otherwise, but Mr. Iacovou, the Foreign Minister of Cyprus whom I saw, could offer me no alternative prospect for his own people and for solving their problems. That is why I regret very much the negative approach that that Government are taking.

John Maples: I am glad, as are many of us, that the Foreign Secretary went to see President Talat, who has proved to be a good and constructive leader of the Turkish Cypriots and who tried very hard to reach an agreement on the Annan proposals. That is in contrast to President Papadopoulos, who many of us believe negotiated in bad faith throughout that period and had no intention ever of endorsing Annan IV, V, VI or any other number. It seems that his strategy was to get into the European Union and then put the squeeze on the Turkish Cypriots by squeezing Turkey. The tragedy is that we allowed that to happen. Does the Foreign Secretary think in retrospect that we should never have allowed the Republic of Cyprus into the EU without settling that problem first?

Jack Straw: Although it was a decision that we made, there was, I think, an all-party agreement on it and it was not an issue of great controversy between the parties in the late 1990s. The problem then was that the Greek Cypriot community had reasonable leadership who wished desperately for a deal both on EU membership and a settlement with the Turkish Cypriot community, but the Turkish Cypriots under Mr. Denktash were almost impossible to negotiate with. Had EU membership been proposed under the current circumstances, neither any British Government nor most European Governments would have touched the idea of allowing a divided Cyprus into the EU. The hon. Gentleman is exactly right to say that, as I suspect, the Government of Cyprus are now seeking to use their membership of the EU to try unacceptably to seek progress on their United Nations-related issues.
	What I said to those whom I met from the Government of Cyprus was that if they go down that road, they will get exactly what they do not want, because they will make it impossible for Turkey to enter into full negotiations for membership of the European Union and then, over time, there will be a status quo in Cyprus which some countries may start to recognise in practice. That is not the position of the United Kingdom Government. We do not recognise the so-called Turkish Republic of Northern Cyprus and we want to see a unified Cyprus, but the current approach of the Government of Cyprus does not in any way represent movement towards a united Cyprus and objectively is likely to lead to the opposite result.

Palestinian Elections

Rosie Cooper: What assessment he has made of the likely impact of the Palestinian elections on the middle east peace process.

Edward Vaizey: What assessment he has made of the outcome of the Palestinian elections; and if he will make a statement.

Jack Straw: As the House is well aware, the Palestinian elections produced a majority in their Parliament for Hamas. We have made it clear that we respect the outcome of any free and fair elections, but we have been equally clear that those who take part in the democratic process have a responsibility to reject violence. The result therefore presents Hamas with a very clear choice. Last Monday the Quartet agreed that all members of a future Palestinian Government must be committed to non-violence, to a recognition of Israel and to an acceptance of previous agreements, including the road map. We, along with our EU partners, will continue to work with the Palestinians, the Israelis and the international community to make progress on the road map, to which both the Palestinian President Mahmoud Abbas and the Israeli Government remain committed.

Rosie Cooper: The Secretary of State has answered some of the questions that I intended to pose. Do the Government support the Israeli Prime Minister on the dismantling of the settlements, as well as calling on the new Palestinian Authority, however it is composed, to renounce terrorism, recognise Israel and commit to peace talks? The Prime Minister of Israel needs support as well.

Jack Straw: I have often applauded the position taken in recent years by Prime Minister Ariel Sharon, and it is a tragedy that he was afflicted as he was a few weeks ago. On the settlements, I should add that in the same statement last Monday 30 January, the Quartet reiterated its view that settlement expansion must stop.

Edward Vaizey: It is not just Hamas that has supported terrorism—Fatah has done so as well. Will the Foreign Secretary use the opportunity of the Palestinian elections to review the aid package of the European Union and of Britain, and ensure that none of the aid that western countries sends to the Palestinian Authority is used to fund terrorism?

Jack Straw: The European Union and the United Kingdom put in place strong accounting measures to ensure that money going to the Palestinian Authority, which was at that stage Fatah-controlled, was not going to fund terrorism. I know that the EU as well as my right hon. Friend the Secretary of State for International Development are satisfied with those controls. For quite separate reasons, direct budgetary aid from the British Government and, I think, from the EU was suspended to the Fatah-dominated Palestinian Authority because we were not satisfied with the way in which some of the money was being accounted for, nor with their budgetary discipline. That aid apart, aid is being paid to people in the Palestinian Authority area. It is important that that should continue for humanitarian reasons, but again, the Quartet, with our full support, made it clear that any future assistance to any new Government would be reviewed by donors against the Government's commitment to the principles of non-violence and the other conditions that I mentioned.

Louise Ellman: I thank the Foreign Secretary for his important statement on Hamas. However, how seriously does he view the articles of Hamas's charter which incite anti-Semitism by propagating the protocols of the elders of Zion and claiming that Jews control the international media and are responsible for revolutions around the world?

Jack Straw: I view those articles extremely seriously. They are completely objectionable and obnoxious. What we look for from the Hamas leadership, if it wants the beginnings of a proper relationship with the rest of the international community, is an indication that it is willing to start travelling away from positions that it has previously adopted. So far, such indications have not been forthcoming.

Nicholas Winterton: I warmly support what the Foreign Secretary has said in response to the questions put to him on this subject. Does he believe that it is absolutely essential for the long-term possibility of peace and stability in the middle east for the western powers, including this country, to maintain a positive ongoing dialogue with Hamas, which has taken over the Parliament in the Palestinian Authority; and, in addition, that we must maintain the help and aid to the Palestinian people while ensuring, as I believe that he has highlighted in his answers so far, that none of that aid will in any way be adapted to assist terrorism against Israel?

Jack Straw: None of us has any interest whatever in, as it were, punishing the Palestinian people for giving the "wrong" answer in those elections. We are very conscious of that. They were free and fair elections and we have to respect the decisions of the Palestinian people. At the same time, nor can we gratuitously reward Hamas if it carries on with active support of terrorism and violence. That is why the Quartet has come to a very responsible and cautious position. Aid that was being paid anyway continues to be paid. The ball is in the court of Hamas. We are not expecting it to stand on its head and abandon overnight every position that it has held in the past. We are expecting from it, however, some clear indications of the direction in which it wishes to travel.
	As to formal discussions with Hamas, insofar as any discussions took place between representatives of the British Government and Hamas, they were suspended some time ago. Whether they could be reopened would depend on the indications that we had of movement by Hamas.

Martin Linton: Does my right hon. Friend agree that the Israeli Government and, to a lesser extent, the United States Government have only themselves to blame for the victory of Hamas, since they cut the ground from under every moderate Palestinian politician by allowing the expansion of Israeli settlements on the west bank in defiance of the peace process, in defiance of the United Nations and in defiance of the law?

Jack Straw: I understand what my hon. Friend is saying, but I do not think that that is the analysis of most members of Fatah as regards what happened. In the debate that is now going on within Fatah, many of its members are saying that it was Fatah that lost the election rather than Hamas that won it, because of its history of being in existence for so many decades and because of allegations of inefficiency and corruption, and worse. I suspect that those in Fatah who are saying that are more likely to be correct in their analysis.

Keith Simpson: The Foreign Secretary has been very robust in saying that through the Quartet we will not be seen to be directly negotiating with or rewarding Hamas until it gives up on terrorism and on its attitude towards the destruction of the state of Israel. Can he tell the House whether he has any evidence that any members of Hamas are involved in terrorist activities directly or indirectly affecting British interests in the middle east?

Jack Straw: I have no evidence that I can put before the House at the moment in respect of that. If there is, I will make it available if it is appropriate for me to do so.

Gerald Kaufman: Is it not undeniable that withdrawal or reduction of aid to the Palestinians because they voted for Hamas will only strengthen their intention to vote for Hamas again, and that punishment of the Palestinians is one of the reasons behind their vote for Hamas? Does my right hon. Friend agree, also, that until poverty, oppression and deprivation among the Palestinians are dealt with, there will be no hope of peace for the Israelis or for the Palestinians?

Jack Straw: As I said, we have no intention of punishing the Palestinians for "voting the wrong way". That is not the appropriate response. That is why the Quartet, with our active agreement, continues to pay aid to the area, with the exception of that suspended to the Fatah Administration before the elections. However, my right hon. Friend would not approve of a position whereby, if a Hamas-based Government were formed and we paid aid, we could not be certain whether some of it was going towards terrorist causes. I do not believe that my right hon. Friend would be happy with that outcome. The Quartet's cautious approach, which we share, of continuing to pay money at the moment because the Administration remains dominated by President Mahmoud Abbas, but subsequently expecting some change by Hamas, is the appropriate way forward.

Cyprus

Edward O'Hara: What assessment he has made of the plans of the Administration in northern Cyprus to develop land in Morphou belonging to Greek Cypriots displaced in the 1974 invasion; and if he will make a statement.

Douglas Alexander: We are aware of construction plans in the Morphou district. Although we maintain a dialogue with the Turkish Cypriots on all aspects of the Cyprus settlement, we cannot control property development in the north. The many difficult and complex property issues in Cyprus are likely to be resolved only as part of a comprehensive settlement.

Edward O'Hara: If the land legally belongs to Greek Cypriot refugees, who were forcibly displaced by the Turkish army in 1974, in terms of international law and human rights, it is illegal and immoral for it to be disposed of in that way. What possible positive contribution can such action make towards finding a solution, which we all desire, to the Cyprus problem? Will my right hon. Friend use all his influence to dissuade the illegal Administration in occupied Cyprus from proceeding with those measures?

Douglas Alexander: I reiterate that we are not in a position to control property development in the north but I agree with my hon. Friend that the status quo is bad for Cyprus, the region and the European Union. That is why my right hon. Friend the Foreign Secretary travelled to the island in recent days to try to give impetus to finding a way forward.

Procurement of Innovative Technologies and Research

Kitty Ussher: I beg to move,
	That leave be given to bring in a Bill to make provision in relation to the awarding by Government Departments and agencies of research and development contracts for innovative technologies; and for connected purposes.
	By being in the House this afternoon, I am missing the funeral of a Labour party colleague and friend, Alan Daiches. Although I am here in body, my thoughts and prayers are with him, his friends and family, in my constituency.
	In his Budget statement last year, the Chancellor made the welcome announcement that all Departments would be mandated to spend 2.5 per cent. of their external research budgets with small and medium-sized companies. That is important because it enables high-tech, science-based start-up companies, which venture capitalists often perceive as too risky, to trial their new ideas in the security of a 100 per cent. funded Government contract. It is good for manufacturing because many of those companies become the manufacturing success stories of the future. As a member of Amicus, I welcome that. It is good for the taxpayer because it will help us to use the latest technologies in this country's universities and business parks to find smarter new methods of solving public policy problems. As a member of the Public Accounts Committee, I welcome that, too. Indeed, I hope that high-tech incubator units, such as the digital technology centre in my constituency, may benefit from the measure.
	The Chancellor's announcement represented a victory for a group of business people, scientists, venture capitalists and academics, who were admirably led in the House by Anne Campbell, the then Member for Cambridge, and outside by the venture capitalist David Connell. I congratulate them both on their achievements.
	The Bill would enshrine the Chancellor's commitment in law. It would make it not only mandatory for Departments to spend at least 2.5 per cent. of their external research budgets on smaller companies, but illegal for them not to do that.
	It is my firm belief that, without a change in the law, the commitment given by my right hon. Friend the Chancellor is unlikely to be translated into reality. That belief is shared by the 13 distinguished academics, scientists and entrepreneurs who signed a letter to that effect in the Financial Times on 19 October last year, and by the 80 Members of this House who signed the associated early-day motion 799.
	We need a change in the law because the co-ordination required by the Whitehall machine is simply too great. The Department of Trade and Industry's Small Business Service does not have sufficient clout over the big research Departments to push through change. Even if it did, there would be no way to ensure that Ministers in those research Departments regarded change as a priority.
	My confidence in the current system has not been bolstered by the fact that it is coming up to a year since my right hon. Friend the Chancellor's announcement, and details of how the new scheme will work are still sketchy. In America, by way of contrast, a policy similar to the one that I propose was enshrined in legislation in 1982, and enhanced a decade later. The results have been astounding. Despite the target of 2.5 per cent., 13 per cent. of all federal Government research and development contracts—worth over $5 billion—now end up with small businesses. The average award is far greater than anything routinely on offer in this country.
	The system in America is carefully designed to help small companies take the first step on the Government procurement ladder. They are encouraged to retain and, indeed, exploit their intellectual property, which means that they often go on to create larger companies. For example, large US firms, such as the biotech companies Amgen and Genzyme and the communications giant Qualcomm, employ 30,000 American people between them, but they began as recipients of small business innovation research awards from the American Government. In 1999, the US Congress concluded that the renewal of the programme would
	"foster innovation, research and technology . . . create jobs and . . . increase"
	America's
	"competitiveness in international markets."
	My Bill aims to replicate the American experience in this country. Specifically, it will set up a process through which, by law, Government Departments will, at twice-yearly intervals and over the web, define their requirements for innovative new technologies. Small businesses would then be invited to bid for innovation contracts of up to £500,000 in value to develop and trial technologies capable of meeting those requirements. Unlike elsewhere in Government, the procurement process would be streamlined, standardised and rapid.
	Without such measures, we are already losing talent and ideas, and therefore jobs and wealth. For example, the scientist Dr. Helen Lee developed in Britain a simple new diagnostic test for HIV and hepatitis, but decided to commercialise it in the US, specifically because of the availability of SBIR grants and awards. She took five people from Cambridge with her to America to help with the process. However, Teraview—widely recognised as the world's leading company in terahertz imaging—decided to stick to the existing system here. It took two years for the company to get a contract out of the UK Government, and that lost it time and money. In addition, all hon. Members have constituency stories of bright new start-up companies that fear that trading with the Government will cause them to lose their intellectual property.
	In conclusion, I urge Ministers to be vigilant in the operation of our policy and to ensure, with legislation where necessary, that it is as successful in every respect as the American model. Our manufacturing companies, jobs and future prosperity will benefit from that success, and so will the taxpayer.
	I thank the House for its courtesy in listening to my speech this afternoon.
	Question put and agreed to.
	Bill ordered to be brought in by Kitty Ussher, Danny Alexander, Janet Anderson, Mr. Michael Clapham, Rosie Cooper, Mary Creagh, Mrs. Claire Curtis-Thomas, Paul Flynn, Mr. Shahid Malik, Andrew Miller, Mr. Austin Mitchell and Mr. Edward Vaizey.

Procurement of Innovative Technologies and Research

Kitty Ussher accordingly presented a Bill to make provision in relation to the awarding by Government Departments and agencies of research and development contracts for innovative technologies; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 3 March, and to be printed [Bill 125].

Opposition Day
	 — 
	[13th Allotted Day]

Mental Health Services

Mr. Speaker: I wish to inform the House that I have selected the amendment in the name of the Prime Minister.

Andrew Lansley: I beg to move,
	That this House notes that one in four people will suffer mental health problems; is aware that mental health trusts are facing some of the largest cuts in planned budgets whilst already having to cope with worryingly high recruitment shortages; further notes that patients with mental illness are often denied real choice in their treatments due to long waiting times for referrals and an acute shortage of non-drug therapies such as cognitive behavioural therapy; is alarmed at the particular problems experienced by black and minority ethnic patients in accessing services; is concerned at the continued absence of a Mental Health Bill almost four years after the first draft Bill was published; and calls on the Government to raise the relative importance of mental health within the NHS, making early intervention a priority in order to enable access to a range of appropriate services and urgently to publish a revised Mental Health Bill which recognises the rights and dignity of people with mental illness.
	May I say at the outset that I am sorry to hear that the Secretary of State is indisposed? We send her our best wishes. We are sure that it will be only a temporary indisposition and that she will be back performing her duties very soon. However, we are happy that the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton), is here to speak for the Government on this subject, for which she is directly responsible in the Department.
	The purpose of this debate is threefold. First, given that there has been no debate in Government time on the Floor of the House on mental health services since 1997, this debate will permit hon. Members not only to assess the future of those services, but to express their appreciation of the staff who work in them and their understanding of the needs of patients with mental health problems. Secondly, we want to express what I hope will be the view of the whole House, namely, that mental health services must not be the Cinderella services of the NHS that many people have often perceived them to be. The services deserve, and must have, priority, and that priority must be reflected in the delivery of the services. Furthermore, that delivery must not be compromised—and patients must not suffer—as a result of present or prospective NHS deficits. Thirdly, we want a reformed Mental Health Bill that people across the range of mental health interests can support to be brought before the House. Such a Bill was promised in the Gracious Speech, but there have been long delays. We want it to contain provisions that will provide dignity and a positive framework for those whom it is intended to serve.

Angela Browning: Does my hon. Friend agree that this so-called reformed Mental Health Bill must address the considerations of the Scrutiny Committee—on which I sat—most of which were rejected by the Government? Does he also agree that any reformed Bill will need to have been really reformed?

Andrew Lansley: My hon. Friend is absolutely right. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) also served on that Committee, and he and I are convinced that substantial changes to the proposed mental health legislation are required. The need for such changes could well be the reason for the delay in introducing the new Bill, but perhaps the Minister will tell us why the delay has been so great. There are things that we need from that legislation, and when we see the Bill in due course I hope that it will have been reformed in such a way as to command the support of the House. I also hope that my hon. Friend the Member for Tiverton and Honiton (Angela Browning), with her experience, will contribute to those debates.

Bob Spink: Will my hon. Friend confirm that there would be fewer people suffering from mental health problems in this country if the Government were to reclassify cannabis as a class B drug?

Andrew Lansley: I am glad that my hon. Friend made that intervention. I had not intended to deal with that issue, but I think that he is right. Leaving aside the criminal justice issues, we should not underestimate the public health issues associated with drug use, and especially with the prolonged use of cannabis by teenagers. Some of the latest research by the Medical Research Council is pointing towards the existence of a common genetic mutation, occurring in about a quarter of the population, that could give rise to a substantial increase in the likelihood of psychotic episodes and schizophrenia as a result of prolonged cannabis use during the teenage years. That evidence should not be just put to one side—it should inform directly the calculation of potential harm that is supposed to underlie the advice given by the Advisory Council on the Misuse of Drugs. Sir Michael Rawlings, who leads that council and is chairman of the National Institute for Health and Clinical Excellence, ought to be rigorous in his examination of the medical evidence underlying those issues. If that has not been true up to now, I hope that it will be in future.

Chris Bryant: I happen to think that we should not have reclassified cannabis in the first place, and I did not vote for us to do so. In part, therefore, I agree with the hon. Gentleman. I must face the fact, however—and I hope that he will face it too—that since that reclassification, the number of young people using cannabis seems to have dropped. How will he deal with that issue?

Andrew Lansley: I will not get into a debate about criminal justice issues. With respect to the hon. Gentleman, I will make my point about the health issue, which I have put on the record. Many Members want to speak and I do not want to take up too much of the limited time available.

David Taylor: Will the hon. Gentleman give way?

Andrew Lansley: No, I will carry on with my speech, if the hon. Gentleman will allow me.
	Let us be clear that combating and overcoming the stigma attached to mental illness is at the heart of what we must do in relation to mental health services. My hon. Friend the Member for East Worthing and Shoreham and I visited the Brent Mind housing project this morning, where we talked to some of the tenants, most of whom have a dual diagnosis of schizophrenia and substance misuse of some kind. In relation to the impact of stigma, our discussion was very interesting. For example, they said that there is still a sense in which the public push the problem not just to the margins, but out of sight and out of mind. There seems to be an assumption that someone who has been mentally ill will not recover, and that the condition is permanent. That is not true. People do recover, medication is capable of assisting dramatically nowadays, and talking and other therapies can be very successful.
	At any one time, 630,000 people might be receiving mental health treatment in this country, but that is only a fraction of the number who will at some time in their lives have mental illness—probably one in four of the population will have mental illness at some time. For many, it is a very traumatic but temporary condition. Therefore, we should not treat people who have mental illness and recover any differently from those who have had a broken leg. People recover and move on. Even if people are on medication, perhaps on a more or less permanent basis, we should not treat them differently. We do not say to diabetics that because they take insulin, their ability to work is necessarily compromised. We support such people, encourage them, help them into work and expect them to be integrated into society. The same should be true of people with mental health problems. Illnesses, whether physical, psychological or mental, should be treated in the same way.

Meg Hillier: As someone who represents a constituency with a high incidence of mental health problems, I find myself in the peculiar position of being in complete agreement with the hon. Gentleman's comments. Can he therefore explain why mental health was not mentioned once in his party's 2005 general election manifesto?

Andrew Lansley: I am afraid that that is not true. The hon. Lady will find a mention of it, and we published substantial material on our approach to the mental health legislation, and the need for it, before the last election. I have a copy of our document with me.

Charles Hendry: My hon. Friend has talked about people recovering from mental illness. Does he agree that what he has said applies particularly to people in prison? Is he aware that 90 per cent. of prisoners have mental health needs, but are treated first and foremost as prisoners, which means that those needs are often neglected? If they are to leave prison, play a valuable role in society and be rehabilitated, should not their mental health needs come first?

Andrew Lansley: I agree, and one of the measures that we have supported is the mainstreaming of health services for people in prison. If primary care trusts are to take over responsibility for that—and most have already done so—it does not bode well if they are trying to cut mental health services at the same time, as too many are. Given that a high proportion of those in prison have mental health problems, primary care trusts must ensure that mental health services are available.
	By courtesy of my hon. Friend the Member for East Worthing and Shoreham, I now have the document relating to the Conservative party's reform of mental health legislation, "Compassion not Coercion", and also the mental health manifesto that we prepared before the last general election.

David Taylor: Will the hon. Gentleman give way?

Andrew Lansley: Not at this point.
	We need to be clear about the current state of mental health services. The Government's amendment understandably emphasises the publication of the national service framework in 1999. As I have said, while it is to be applauded as a statement of priority, we need to ask what it does in terms of delivery. Let us examine some of the national standards contained in it.
	First, there is the intention that there should be health promotion and that discrimination should be combated. Spending on promotion of mental health specifically has fallen to £2 million, a tiny fraction of the mental health budget, and is 60 per cent. lower than it was in 2001. As for discrimination, I am afraid that it is still unhappily true that black African and Caribbean patients are 44 per cent. more likely to be detained.
	The second national standard emphasises access to diagnosis and effective treatment. Access to cognitive behavioural therapies is seriously lacking. In his recent report, Professor Layard said that we needed 5,000 more psychological therapists, and the Sainsbury Centre for Mental Health recently spoke of GPs with no access to CBT for their patients and a wait of up to six months for counselling. Responding to a survey by Mind, 47 per cent. of mental health service users said that their treatment was held back considerably by not being given the treatment that they needed. That standard, too, has not yet been met.
	The third standard relates to round-the-clock contact. Crisis resolution and assertive outreach services are of course useful, and they have perhaps been the principal innovation of the national service framework. However, if core services are plundered so that crisis resolution and assertive outreach services can be fed, the net effect will be that although it may be possible to intervene at night and try to deal with a problem—and I know that many GPs' out-of-hours services value crisis resolution—the system will not work if the patient cannot be dealt with immediately the following morning.
	The fourth standard recommends a care programme, but 50 per cent. of mental health service users are not offered a care plan. The fifth standard refers to timely access to hospital beds. Just over a fortnight ago, the Mental Health Act Commission said
	"Over half of all wards are full or have more patients than beds."
	As an indication of the way in which mental health services are viewed, what could be more compelling than the simple fact that when the Healthcare Commission's patient environment teams looked at hospitals, the only six that they found to be unacceptably dirty—they described those hospitals as "standard 4"—were mental health hospitals? As Members will know, given the definition of "unacceptably dirty", that was a pretty condemnatory conclusion for the teams to reach.

Philip Hollobone: Does my hon. Friend share my concern that a recent Health Service Journal report highlighted that over half of hospital chief executives have had to consider closing some of their mental health facilities, including at Kettering general hospital in my constituency?

Andrew Lansley: I am grateful to my hon. Friend. He leads me on to the area that I want to turn to next.
	There have been improvements and extra resources, but the resources going into mental health services have not kept pace with the resources committed to the national health service as a whole. That is an indication of its relative lack of priority.

Jim Devine: rose—

David Taylor: rose—

Andrew Lansley: I will not give way for the moment.
	Some of the progress that has been made is directly threatened because of the reductions in funding to meet deficits. It will not surprise hon. Members that I want to talk about Cambridgeshire. It is one of the areas where the cuts in mental health services are most profound. A letter was sent to me just a fortnight ago by psychologists and psychological therapists working for the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. They say of the changes in Cambridgeshire:
	"these are not minor trimmings or adjustments to services: they are cuts of essential, frontline services."
	We are talking about the closure of in-patient beds. What most distresses me and many people in Cambridge is the closure of Douglas house, which provides a young people's service, and the cutting of access to services for young people.
	I have raised that matter with the Secretary of State. We have had meetings. I have received correspondence. Everyone in Cambridge knows perfectly well that it all tracks back to the Government's failure to reflect adequately the genuine mental health needs in Cambridgeshire, and in Cambridge in particular. They should look not at their own demographic analysis, but at the actual demand and need in the community. All the Secretary of State keeps telling us is that it is not her responsibility but that of the local primary care trust. The trust keeps saying, "We just do not have the money to reflect the need that we have." When we go back to the Secretary of State, she says, "The statisticians have done their work and the work is as good as we can make it." So everyone is responsible except the Secretary of State—it is the statisticians and the primary care trust that are responsible. Never does she take responsibility for the impact of her changes and cuts.
	The predicted deficits in mental health trusts are nothing like as serious as the cuts in services will be. The PCTs are shifting deficits into mental health trusts. Thatis affecting not just Cambridgeshire but Oxfordshire, which has lost seven consultants, and seven senior house officer and registrar posts. Mental health wards have closed in Westmorland. Supporting people budgets have been reduced in many parts of the country. In south-west London, particularly in the St. George's Mental Health NHS Trust, there have been widespread reductions and there is a major deficit. Psychiatric beds have closed in West Park hospital in Durham. In Lambeth, there is the potential closure of the Maudsley emergency clinic. There is also the possible closure of a mental health ward at Loughborough or Coalville hospitals. There are other examples.

David Taylor: Perhaps the hon. Gentleman is being a little unfair on the Government, who have increased resources in real terms by 25 per cent. There are now 8,000 psychiatric nurses, 1,200 consultants and 3,000 clinical psychologists. He seems to be drawing together examples from university towns—Cambridge, Oxford, Loughborough and elsewhere. Does he agree that we need to do much more in the FE and HE sectors to promote mental health? Ten per cent. of young people between the ages of 11 and 25 self-harm, suicide is the cause of 20 per cent. of the deaths of young people and the age group that commits suicide the most is young men aged between 15 and 24. Should not more be done in that regard?

Andrew Lansley: At least the House is spared a speech from the hon. Gentleman by virtue of that intervention. I say two things to that. First, £30 million is now being spent on student counselling services. It is much increased. That is a measure of the need among students for mental health services. Secondly, in Cambridge, as the hon. Member for Cambridge (David Howarth) will know—

David Howarth: Will the hon. Gentleman give way?

Andrew Lansley: No. I will make the point because I know what the hon. Gentleman would say.
	If the Government's statisticians treat students as affluent because they are not on benefit, and therefore as having much less mental health need, they are plain wrong. That is a good illustration of the absurdity of the way in which the mental health needs index is compiled.

Nicholas Winterton: Will my hon. Friend give way?

Andrew Lansley: No, because I have to finish. I beg my hon. Friend's pardon, but I have to conclude my speech.
	We need to be vigilant about mental health service cuts because there is a major risk. Not only has there been less of a priority for mental health services than for other services, but with PCTs having to pay acute hospitals dramatically increased costs and having no choice but to pay for the GP contract, it is mental health services such as community hospitals that are bearing the brunt of the reductions in services.
	We must look for a positive change in the future, in terms of priority and of the mental health legislation, which I hope we will have an opportunity to debate in substance when the new Bill is published. However, it must be a Bill that has neither a broad-ranging definition of mental disorder nor a broad-ranging definition of medical treatment, while giving an opportunity for community treatment orders to be imposed on a widespread basis. There are many people—particularly from the black and minority ethnic communities—who know that they are far more likely to be the subject of detention and who fear that the extension of such orders in the Bill will lead to widespread assumptions that they can have community treatment orders imposed upon them.
	There is a major risk with the legislation that instead of achieving greater safety for the community, it will undermine compliance and support for patients in the community. Patients will not wish to present to mental health services and we will end up with patients untreated and the community less safe. That is the risk with the Government's legislation.
	What do we need for the future of mental health services? We need the Bill to be published in a way that is geared to the positive treatment of patients, encourages compliance with treatment and supports clinicians in what they have to do, rather than taking the Home Office approach of coercion. Mental health services need greater priority and I want the Minister to tell the House that the increase in mental health resources will match the increase in NHS resources as a whole. We need to bring mental health more into the mainstream, so that GPs have greater access to mental health budgets for their patients and more responsibility for seeing the whole of the mental health patient pathway, rather than their being, as at present, more or less forced to abdicate responsibility and hand it over to mental health trusts.
	Patients need more choice. At the moment there is no "choose and book" for mental health patients. Indeed, the Government have also virtually given up on direct payments for mental health patients. Mental health patients do not have control when, sometimes, their exercising greater control over the management of their care can in itself make a major contribution to the way in which they can make progress.
	We must have dignity through the Bill, we must have no discrimination and we must have support for carers. At the moment, many carers who are supposed to have annual appraisals very often do not have an appraisal of their needs. We need them to be supported. We need all of that, and we need more. However, what we need most of all is to understand that the stigma of mental illness is completely misplaced. All of us are at some risk of mental illness at some time in our lives and we would not want that stigma to be applied to us. We would wish those services to be available for us if we needed them, so we should do no less for our constituents.

Rosie Winterton: I beg to move, To leave out from 'House' to the end of the Question, and to add instead thereof:
	"recognises that the Government has made mental health a key priority through the National Service Framework for Mental Health and the NHS plan; welcomes the achievements set out in the National Director's progress report published in December 2004; further welcomes the record increases in investment and staffing; notes that under this Government there are now over 700 specialised community mental health teams and that suicide rates are the lowest since records began, that there are 1,200 more consultant psychiatrists, over 3,000 more clinical psychologists, and 8,000 more mental health nurses than in 1997; further welcomes the Government's five year action plan to tackle inequalities in mental health services amongst black and ethnic minority communities and its action to tackle social exclusion in mental health; acknowledges the Government's commitment to early intervention to support good mental health and improve preventative mental health services in the community, as set out in the recent White Paper "Our health, our care, our say: a new direction for community services", including by improving public understanding of mental health issues to counteract stigma and discrimination, expanding access to psychological therapies including cognitive behavioural therapy, promoting the use of information technology recently reviewed by the National Institute for Health and Clinical Excellence which supports people to take charge of their own treatment, and working with health professionals to improve standards in mental health services in the community; and further welcomes the Government's commitment to reform mental health legislation as soon as parliamentary time permits."
	The Secretary of State for Health has been taken ill and apologises to the House for being unable to move the amendment.
	As the hon. Member for South Cambridgeshire (Mr. Lansley) said, one person in four will suffer from mental ill health during their lives. Mental ill health can have a devastating effect, not just on individuals but on their families and society as a whole. Social exclusion, discrimination and stigma add to the suffering. Less than a quarter of adults with long-term mental health problems are in work. They are nearly three times more likely to be in debt, and can struggle with basic requirements such as transport or decent housing.
	More than 1 million of the 2.7 million people claiming incapacity benefit list mental or behavioural conditions as their main disability. It has been estimated that mental illness costs the country up to £25 billion a year—in other words, 2 per cent. of gross domestic product. That is why this Government have recognised the importance of mental health to the well-being of the whole nation, not just of individuals. Along with cancer and coronary heart disease, mental health is one of our top three health priorities.
	By 1999, within two years of taking office, we had published the national service framework for mental health—a ground-breaking and ambitious 10-year programme of reform and investment for mental health care in England.

Julie Kirkbride: I recognise that the Government have spent more money on mental health services. The Worcestershire Mental Health Partnership NHS Trust invested money in providing a home care service and we are very grateful for that, but the downside is that the Government are now saying that we must live within our original budget. The result is that mental health care in-patient beds are being cut to make the figures add up. Can the Minister explain why that is happening?

Rosie Winterton: If the hon. Lady will allow me to make a little progress, I will come to some of the points that have been made about the financial situation in mental health and the effect on trusts themselves.

Jim Devine: My hon. Friend will be aware that I worked as part of a primary care psychiatric team when the Conservatives were in power. They introduced a policy called care in the community, which was in a fact a con in the community, and led to many psychiatric patients wandering around city centres throughout the United Kingdom. Since then, have we not introduced a co-ordinated strategy consisting of investment not just from the health service, but from local government and the voluntary sector?

Rosie Winterton: My hon. Friend describes very well the direction in which we are travelling, and it is important that we have such support in the community; we need input not just from the health service but from local government and the voluntary sector. I have seen some very good examples of the three working together to make an incredible difference not just to people with mental health problems, but, crucially, to those who support them—their carers, families and friends. Such support in the community is vital.

Nicholas Winterton: I am grateful to my namesake for giving way. Will the Minister not express some concern about the over-rapid closure of mental hospital beds, which has caused huge problems not only for the mentally ill who really should be accommodated in hospital, but for their families and the community? Community care has an important role to play, but have not too many hospital beds been closed? Will she consider that issue, and in particular the proposed closure of acute mental hospital beds in east Cheshire by the Cheshire and Wirral Partnership NHS Trust?

Rosie Winterton: Perhaps I can combine my answers to the interventions that have just been made. Rapid closure under the previous Administration left people vulnerable in the community, and I hope to demonstrate that this Government have provided support in the community through crisis resolution teams and early intervention teams. The idea is that in-patient care should become very much the last resort. I hope that Members appreciate that removing people with mental health problems from their families and their home environment is not always the best road to recovery; if we can support them in their own homes, that is the way to go. I have visited a number of places where it has proved possible to switch resources from in-patient care to community home care teams, and we should not underestimate the importance of making that shift.
	Such reshaping of services can help people to live for longer in the community and to avoid removal to hospital, which is sometimes inappropriate. That approach is ambitious, and that is why we have a 10-year programme. In many instances, it requires services to make switches that they may not be used to, but once the changes have been made, a big improvement has been seen. The plan followed widespread consultation and was warmly welcomed by the professions. I accept that professionals would like to see further changes, but in general the plan has been well received. In 2000 we followed it up with the NHS plan, which set some clear targets for mental health services.

Tom Clarke: I welcome what my hon. Friend says, but does she agree that if the strategy is to succeed, advocacy should be at the heart of Government policy? Will she confirm that it is still there?

Rosie Winterton: Of course, and I hope that my right hon. Friend welcomed the announcement about the advocates for people with mental incapacity, which we discussed at some length during the proceedings on the Mental Capacity Act 2005. He is right to say that advocacy is an important part of ensuring that our mental health services are modernised.

Julian Lewis: I accept what the Minister says about the desirability of people being treated in the community if possible. Will she in turn accept that if someone suffers from an acute psychiatric breakdown there is no prospect of their being able to look after themselves in the community, and they will need to be an in-patient? It is important that such an in-patient should not be put in with people with different types of mental illness, who may be psychotic or even violent. What progress have the Government made to ensure that regard is had to the very different types of mental illness, so that people are treated separately where appropriate?

Rosie Winterton: It is important to ensure that people who are dangerous or violent are held in more secure units than those suffering, for example, from a clinical breakdown. That is why we have increased the number of medium secure beds, why we have looked at changes for the high-security hospitals and why we have many more low secure beds. It is important that we make the distinction between people who need a secure environment and those who do not.
	It is also important to recognise that people may reach a crisis point, and to ensure that if they need to spend some time in in-patient care, it is the minimum period necessary for that individual. We need to have the modernised services that I have mentioned in place—made possible through our increased investment, which I shall talk more about later—so that the time spent in hospital is minimised. That is because people often make a better recovery if they can have help in their own homes and communities.

Lynne Jones: It is good that the Government are giving community care a high priority, although perhaps not as high as some of us want. It is also good that the Opposition, by initiating this debate, are showing their commitment to improving mental health services.
	On the subject of in-patient beds, is my hon. Friend not concerned about the huge increase in the number of patients who are in private facilities? The Mental Health Act Commission report cited by the hon. Member for South Cambridgeshire (Mr. Lansley) pointed out that the number had increased from 700 to 2,300 and although those institutions may have been cleaner, which is good, they had poor back-up facilities for emergency care. They are also expensive, so why is the NHS not improving its own in-patient provision?

Rosie Winterton: Recently we announced investment of £130 million to improve in-patient facilities—but my hon. Friend is right, in that there has been a long tradition of using the independent sector in mental health care. We need to look closely at the commissioning that PCTs and others undertake in the private sector, to ensure that they carefully consider local needs so that people can remain as close to home as possible. There have been big advances in that commissioning, but we can certainly make improvements and I want to ensure both that we get good value for money, and that care takes place as close to the patient's home as possible, so that people can obtain the necessary back-up.
	The national service framework was accompanied by record investment. According to the European Commission, the UK has one of the highest proportions of its overall health budget devoted to mental health of any EU member state. Those extra resources, which the Opposition voted against, have been put to good use. Compared with 1997, when we took office, we have 20 per cent. more psychiatric nurses, 50 per cent. more consultant psychiatrists and 75 per cent. more clinical psychologists. The suicide rate has fallen to its lowest recorded level and, again according to the European Commission, is one of the lowest in Europe. I hope that all Members welcome that.
	The NSF proposed 170 new assertive outreach teams for people at risk of losing touch with conventional services—I think that was the point that the hon. Member for New Forest, East (Dr. Lewis) raised. By March 2005, there were 262 such teams, providing badly needed support to about 20,000 people. In addition, the NHS plan envisaged 335 crisis resolution teams to give intensive support at home to people suffering a crisis in their mental health. By March 2005, there were 343 teams and they had been able to help nearly 50,000 people.

Jim Cunningham: How can we help carers? They often carry a financial burden and are also under stress. How do their needs fit into the 10-year plan?

Rosie Winterton: I agree that the needs of carers, especially those who look after people with mental health problems, are paramount. In the NSF, we have tried to provide extra support for carers, not least in the difficult situations that can occur. Sometimes it is difficult for a person to live close to someone with a mental health problem, and such situations need to be managed. In the White Paper, we set out a raft of measures in relation to carers, which, obviously, will apply to people caring for those with mental health problems. The best services that I have seen are those that have involved not only service users, but carers as well, in shaping them.

Anthony Steen: There is not much point in closing down purpose-built institutions for residential mental health care, such as the Brischam unit in Brixham, on the basis that people with dementia would prefer to be looked after by carers in their own homes, if the carers are driven to distraction by having nowhere to send their cared-for person with dementia, because all the purpose-built residential homes have been closed down.

Rosie Winterton: The hon. Gentleman is referring to the need for good respite services. It is not necessarily perhaps a case of the constituents to whom he alludes wanting their loved ones to be elsewhere; they want a combination of care and support at home, with respite facilities as well. He is right to say that we all need to consider how we can increase those respite facilities, sometimes by turning inappropriate beds into respite care beds. That is an important approach to take, and it is sometimes important to consider what lies at the end of such proposals. For example, if a trust is talking about closing an institution, it should consider whether any such decision is backed up by a different type of service that better fits patients' needs, and respite care is very often involved.

Chris Bryant: Does my hon. Friend agree that having some form of mixed economy in mental health service provision is important? The residential rehabilitation service that may be appropriate for one person with a drug or alcohol problem may be wholly inappropriate for another, yet residential rehabilitation might be necessary for others—perhaps provided by the voluntary sector, which offers a very different style of service from that which is available from the state.

Rosie Winterton: My hon. Friend makes an important point. We need to make better use of the voluntary sector, because in many senses it has been able to reach out to people who may not have been gaining access to services. We need to maximise the use of those skills. Last year, I launched some guidance with Victor Adebowale. It was all about how trusts needed to look closely at their relationship with the voluntary sector, and how they could operate services jointly. That approach fits in with our recent White Paper, and it applies particularly to mental health.

James Duddridge: Will the Minister give way?

Rosie Winterton: I need to make some progress.
	In total, more than 700 new multi-disciplinary teams are now working for mental health in the community. The NHS plan proposed expanding by 150 the capacity for secure places for people with severe personality disorders. We now have 205 of those new places. The NHS plan set a target of 500 community gateway staff—experienced mental health professionals—to improve patients' access to specialised services. We now have more than 1,500 of them, compared with our target of 500. The NHS plan also set a target of 50 early intervention teams for younger people who experience the first onset of psychosis, and we now have more than 100 of those teams.
	I should like to take this opportunity to pay tribute to the many thousands of people who work in mental health services. Too often they go unrecognised, but without them we would not have been able to make real improvements in services for some of the most vulnerable and often excluded members of our society.

David Taylor: The Government amendment spells out some of the progress that has been made, and several trends are encouraging. Does the Minister agree that among young people, levels of self-harm and indeed suicide, especially among young men between the ages of 15 and 24, are distressingly high? Is she planning any initiatives to target young people, especially those in higher and further education who are living away from home? There is still a problem to be resolved.

Rosie Winterton: My hon. Friend is right, because obviously, any suicide is a suicide too many. However, the success of the suicide strategy has meant that the numbers have dropped considerably and we are leaders in the European Union. There are a range of things that we can do to support more people in the community, but I will come to that later.

Several hon. Members: rose—

Rosie Winterton: I will give way to the hon. Member for North Shropshire (Mr. Paterson) and my hon. Friend the Member for Stoke-on-Trent, South (Mr. Flello), and then I will move on.

Owen Paterson: I thank the Minister for giving way—she is being very generous. When I went to see her in July, I mentioned Shelton hospital, which is set to be the last working Victorian asylum unless it is rebuilt, which is the plan of Shropshire County primary care trust—the lead organisation—Telford and Wrekin PCT and Powys local heath board. Five years ago, the cost of the project would have been between £40 million and £50 million, but it has now grown to £85 million. The strategic health authority has put the project on hold because of the problems in Shropshire's health economy. If the delays carry on, there will be a bill of £400,000 each month. When does the Minister think that the last Victorian asylum will be replaced, thus saving taxpayers the £400,000 that is lost for every month that the delay continues?

Rosie Winterton: The hon. Gentleman knows very well that it is for his local trust and strategic health authority to examine that matter closely. It is important to move services into the community as much as possible. Obviously we must preserve some in-patient care, but the more we can provide modern reformed services in the community, the better. We have announced extra investment to improve in-patient facilities, but that matter is for local discussion.

Robert Flello: Much of the debate has been focused on adult mental health services and services for younger adults, especially in relation to suicide. Will my hon. Friend say a few words about mental heath services for children and adolescents, and the fantastic work that is done in that area?

Rosie Winterton: My hon. Friend is right to say that excellent work is done in that area, too. There have been shortages in some of the professions involved in mental health services for children and young adults, so we are trying to address that problem. It is important to ensure that there is co-ordination between mental health services for younger adults and those for older ones. Too often people get caught in one area or another, which causes enormous difficulties. We have taken steps to ensure that there is better co-ordination, and our tsar, Professor Louis Appleby, has taken an overall strategic view on that.

Liz Blackman: Will my hon. Friend give way—at a suitable point?

Rosie Winterton: At a suitable point, I will.
	In 1999–2000, the NHS and social services spent £4.74 billion on mental health services. In 2003–04, the figure had risen to more than £6 billion, which was an increase of more than 27 per cent, or a £1.2 billion increase in real terms. As was shown in a recent independent survey of planned mental health investment, the increase has continued in subsequent years. There has been an increase every year since we published the national service framework. Such unprecedented investment has allowed us to make significant improvements to mental health services.

Liz Blackman: My hon. Friend will agree that early identification is paramount; often, people who are developing mental illness first come into contact with generalists rather than specialists. What conversations has she had with professional bodies representing different medical practitioners about making mental health a core component of their training?

Rosie Winterton: We have been looking closely at specialist GPs, who can make an early diagnosis. We also want to facilitate the professional exchange of information, so that practitioners can look out for those early symptoms, and they can be followed up by intervention teams if people are obviously deteriorating.
	I want to address some of the points that the hon. Member for South Cambridgeshire made about what he called cuts to mental health services, and it will be helpful if I set out some of the facts. In response to concerns expressed in the past few months, we recently asked for information from all 28 strategic health authorities. Twenty of them reported no reductions to planned expenditure on mental health services this year; the remaining eight reported that there would be reductions in planned expenditure affecting 11 trusts—11 trusts, of 84 trusts in England. Those trusts had planned to spend £894 million this year, and they are reducing their planned expenditure by a total of £16.5 million—2 per cent. of the total.
	To summarise, 11 of 84 trusts are making expenditure reductions that amount to £16.5 million out of a total expenditure on mental health of more than £6 billion—0.3 per cent. of the total. Of course, in the light of the extra investment that we have made, we would prefer it if there were no planned reduction in expenditure. However, I hope that I can assure right hon. and hon. Members that strategic health authorities are working with those trusts to minimise any impact on patient services.

Anne Milton: Does the Minister agree that despite the figures that she has quoted, many people working in mental health services, particularly in the community, still feel that they are part of a Cinderella service, that there are huge gaps in their opportunity to deliver services, and that those gaps are being filled week after week, day after day, by those working in the voluntary sector?

Rosie Winterton: I believe that there has been a turnaround in the delivery of mental health services in this country, owing to the extra investment and the changed ways of working. It is important that we, as Members of Parliament, recognise those changes. There have in the past been difficulties in recruiting people to mental health services because they are constantly told that those are Cinderella services that are on their way out. We must recognise that mental health care is an exciting place to work, with new, modernised, reformed services that have received extra investment. We must recognise, too, that three out of four patients who use mental health services are very satisfied with the service that they receive.
	I turn now to our plans for mental health services, as set out in our amendment.

Edward Vaizey: Will the Minister give way?

Rosie Winterton: I have taken a number of interventions, and I am afraid that if the hon. Gentleman's Front-Bench colleagues are complaining about the time that I have taken, I can take no more interventions.
	We have introduced many new community services, but as I have said, it is also important to ensure that there is high-quality in-patient care, which is why we committed £130 million of capital investment to that. However, it is true that some people are still waiting too long for treatment and some are having difficulty in accessing the sort of treatment that they would choose for themselves, particularly psychological therapies such as cognitive therapy. For people with signs of mild depression or anxiety, psychological therapies can extend choice, reduce waiting times and help to keep them in work or support them in getting back into work earlier.

Linda Gilroy: Earlier in my hon. Friend's speech she referred to 40 per cent. of the people on incapacity benefit, and I welcome her point about early intervention. Would she give encouragement to staff at my local Jobcentre Plus whom I met yesterday, who are keen to work with GPs and offer them support in that important area?

Rosie Winterton: I am pleased to hear that my hon. Friend's visit to Jobcentre Plus had such productive results because, as the pathways to work project has shown, extra help and advice can make a real difference to getting people back to work.
	We are committed to widening access to psychological therapies as a supplement to medication, as recommended by the National Institute for Health and Clinical Excellence, and we clearly set that out in the White Paper that we published last week. We will be looking to provide faster access to more specialised services for those who need them, and more choice for people in the kind of care that they receive, and in who provides that care. We will set up two demonstration sites that will focus on people of working age with mild to moderate health problems and aim to help them stay in, or return to, work. We also know that people with mental health problems suffer from serious inequalities in physical health, which is why our White Paper on public health set out a series of ways to tackle those inequalities.
	The hon. Member for South Cambridgeshire spoke of access to, and experience of, mental health care for black and minority ethnic communities. For decades the problem went unrecognised and unchallenged. We have begun to change that. A year ago, following the report on the death of David Bennett, we published "Delivering Race Equality in Mental Health Care", a comprehensive five-year action plan to put right what was clearly unacceptable. One of the first steps along the way was last year's census of mental health in-patients. It confirmed the problems that we knew existed for people from black and minority ethnic communities. That is why, alongside the census, we have chosen 17 places throughout the country that are leading the implementation of the five-year action plan.

Anthony Steen: Will the hon. Lady give way?

Rosie Winterton: I cannot.

Anthony Steen: Just a quick one.

Rosie Winterton: There is no such thing, I am sure, especially in the hon. Gentleman's case.
	The hon. Member for South Cambridgeshire talked about the draft Mental Health Bill. We will introduce the Bill when parliamentary time allows. It is vital that we modernise mental health law and bring it into line with human rights legislation. Where compulsory treatment is necessary, we must reach a quality and level of service that gives people the treatment that they need and minimises the need for further periods of compulsion. These are not easy issues to deal with, but we are determined to do so.
	Improving the mental well-being of individuals and our wider community, and tackling the stigma and discrimination suffered by those with mental health problems, will not be achieved simply by modernising mental health legislation and reforming mental health services. We need an approach that stretches across Government, which is why in 2004 we published the social exclusion unit report, which sets out a series of steps that need to be taken by the Government at all levels. For example, we need to examine access to housing, employment and a range of local services, which many of us take for granted. That is also why we published the health, work and well-being strategy at the end of last year, which looks at how to help people stay in work, and also how to help people back to work. That was part of the overall direction of travel set out in our recent Green Paper on welfare reform.
	Let us recall the situation 10 years ago, and how mental health services looked then. We had thin community services, modern treatments were rationed, and the use of the Mental Health Act 1983 was rising year on year because of pressure on acute care. There was no clear policy direction, and there was no action in critical areas, such as the care of people from ethnic minorities. Anybody who was working in the service 10 years ago, and who looks at it again now, knows how much has changed. It is no longer a Cinderella service. It is a vital and thriving part of a modern national health service.
	Our record on mental health is one of unprecedented progress and achievement. What I have described today is a serious, radical and long-term programme of change and modernisation. That is the future of mental health care under this Government. I urge hon. Members to vote against the Opposition motion and for our amendment.

Steve Webb: I begin by reinforcing the Minister's words of praise for those in the national health service and the voluntary sector who work with people who have mental health problems. I am sure that all hon. Members who meet those who work on the front line admire their commitment and dedication. Many of them are doing jobs that I would find very difficult.
	I welcome the fact that we are having the debate, and the selection of subject matter. It is a neglected topic of debate in the Chamber. In the eight months that I have been spokesman for our party, this is the first opportunity that I have had to debate it in the Chamber. I hope that the choice of subject represents a genuine change and a genuine commitment by the Conservatives to the NHS, and that it bears no relation to the recent letter from the Conservative leader to his colleagues, urging them to get active on the NHS and shed the party's negative image on the health service. I hope it is a lasting commitment.

Julian Lewis: The hon. Gentleman will recall that he entered the House in the same year as I did—1997—and that having come second in the ballot for private Member's Bills, I introduced a Bill on mental health services. I am grateful for the strong support that I received from the Liberal Democrats at that time, so the hon. Gentleman should be aware that there is a tradition among Conservatives of being concerned about these matters. I did not hear the Minister say anything about the abolition of mixed sex wards, which was an interest that the hon. Gentleman and I had in common. Is he aware of what progress has been made, and will he put that to the Minister?

Steve Webb: I am happy to pay tribute to the hon. Gentleman's personal record on these matters. Mixed sex wards are an important issue. There was a Labour manifesto commitment to get rid of them entirely, yet one in four patients across the national health service, including all forms of health care, still experience a mixed sex ward at some point during an in-patient stay, which is a long way from the rhetoric. I hope that in winding up, the Minister will be able to address the up-to-date position on that.

Anthony Steen: Will the hon. Gentleman give way?

Steve Webb: Not at the moment. Those on the Conservative Front Bench are keen that as many as possible of the hon. Gentleman's colleagues get in.
	When one reads Government amendments in debates such as this, one often wonders what world they are describing. We have just heard the Minister describe an unprecedented programme of achievement and progress. As an antidote, so to speak, to the Government rhetoric on the health service, the Liberal Democrats some months ago established a website designed to give members of the public around the country an opportunity to feed in both good and bad experiences of the health service. We have received many comments through libdemnhswatch.com about what is happening in mental health services around Britain. I shall refer to one or two examples, which put a different perspective on the Government amendment and the Government's spin.
	One submission that came in a couple of months before Christmas was from a gentleman in the Bristol area, who wrote:
	"I would comment on the provision of mental health care as little or none. I suffered from depression and was given tablets and a list of private practitioners who I could contact—this was not the GP's fault, and indeed she did all she could to listen, and take care of me to the extent that the NHS provides for."'
	One of the themes of my remarks is that GPs are in the front line of mental health provision. The GPs to whom I talk say that perhaps three quarters or four fifths of mental health provision is done by GPs, many of whom are not trained to any great degree to do it, and that perhaps a third of GPs' time is taken up with mental health issues. There is a real gap—I do not mean this pejoratively—between the relatively superficial level of support and care that an untrained generalist can provide and the most acute in-patient care. There are some very big gaps in that spectrum and, as a result, problems arise from the lack of preventive work being done in the community.
	The person who contacted us talked about raising £400 scraped together out of a student loan, which comes back to the point about young people with mental health problems. He says:
	"I spent 8 months on some very pricy drugs, at around £150–£250 cost to the NHS every 2 weeks . . . Had I been treated with therapy,"—
	which is mentioned in the Conservative motion—
	"one of the long term solutions, . . . the NHS would probably have saved money!"
	If the NHS can deal with people effectively up front, it will potentially save money.

Adam Afriyie: Will the hon. Gentleman give way?

Steve Webb: Not at the moment, but I will endeavour to do so later.
	The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned the situation in his county. I shall give an example from our website about Cambridgeshire mental health services. The lady concerned says that, as a result of the cuts in Cambridgeshire mental health services,
	"my son . . . will lose his care nurse and contact with his consultant".
	She goes on:
	"Cambridgeshire used to be an example of outstanding care in this field . . . but now this is being broken up as too costly (for the NHS), pushing responsibility onto Social Services Departments which do not have a good record."
	That is a vital point. The Minister says, in effect, "Well, it is only 16 million quid", but these individual human stories show that for every small cut in provision, there is real human misery. The Minister should not dismiss £16 million of cuts. She implied that it is nothing terribly significant because it is only a fraction of 1 per cent. That is not accurate.
	My key point concerns the link with social services budgets. Until these are single budgets, we will get this absurd cost and deficit-shifting and lack of an holistic approach to people's overall care and health needs. If cutting health provision merely shunts the cost on to someone else, we will not get the decision that is in the best interests of the patient or member of the public but the decision that works best for the individual ring-fenced budget. That cannot be a rational way in which to proceed.

Edward Vaizey: The snapshot of cuts that the Minister mentioned is literally that—a snapshot. In Oxfordshire, we will lose £5 million of our mental health budget, but that is over a period of three years. The hon. Gentleman is right to say that every cut has an effect. We have just lost the Ridgeway day centre in Didcot, which is a good example of a service that will not come back.

Steve Webb: I am grateful to the hon. Gentleman for highlighting the fact that whereas the Minister was talking about cuts in the current year's budget, some of them will go on, and accumulate, for much longer.
	The hon. Gentleman mentioned Oxfordshire. Another person who visited our website commented that when they became ill in Oxfordshire some years ago, they received treatment that they described as being of a good standard, but that recently
	"Oxfordshire Mental Healthcare has been severely affected, the psychiatrist that I saw has now left, and there is a chronic shortage of"
	community psychiatric nurses. He goes on:
	"People who now suffer as I once did are not receiving the treatment that I was so fortunate to have".
	That is the main concern. Perhaps this is absurdly naive of me, but if Government amendments were more balanced in recognising that while they can cite statistics that show improvement, there are also worrying areas, one might almost think about voting for them. We cannot do so, however, while they remain so Panglossian in saying that everything in the garden is rosy.
	I want to highlight a couple of other individual cases. We can trade statistics in such debates, but never get to the kernel of the issue. I was approached confidentially by a constituent who has given me permission to cite his case. His wife had suffered from suicidal tendencies. This was another instance of GPs wanting to help but being unable to cope. He said that
	"it cannot be acceptable that somebody with suicidal tendencies (my wife has threatened suicide over 80 times since 1997) cannot get help until they actually take the step to kill themselves".
	In a crisis, the urgent in-patient services step in but there is a huge gap in the middle, and a lack of support and training for GPs.
	The GP may not always be the right person for someone with mental health problems to see. The GP may not respond appropriately and the person with mental health problems may not feel able to go to a GP. Has the Minister considered other routes for accessing the health service, for example, through access workers? Are the Government trying out those approaches?

Anthony Steen: Will the hon. Gentleman give way?

Steve Webb: No, I shall not. [Hon Members: "Go on."] No, not even briefly.
	Before I consider broader policy matters, I want to examine emergency provision in circumstances in which a family member with mental health problems, who perhaps lives in a care setting, comes home, for example, for Christmas and things go wrong. I have recently come across two cases of people with mental health problems spending the night in a prison cell. Parts of the country have a protocol whereby that should not happen, but it has happened twice in my area relatively recently. At short notice, there was nowhere for those people to go and they ended up in a prison cell. That was traumatic for the family and the individuals, and the police knew that it was the wrong place for them. Will the Minister say something about short-notice crisis provision and alternatives to a prison cell?
	As I said, we must consider whether GPs need substantially more training and whether there are alternative ways of accessing mental health services. However, we must take into account not only the mental but the physical health of those with mental health problems. When I recently attended an event that was organised by the charity Rethink, I was startled to discover that people with severe mental health problems can expect to live perhaps 15 or 20 years less than someone with similar physical problems.
	For example, American evidence shows that people with severe mental health problems who develop cancer are 50 per cent. more likely to die of it than those without mental health problems. There are genuine worries about the ability of people with mental health problems to access care for their physical health. Looking after people's physical health helps their mental health. We need a much broader agenda that does not separate budgets for mental health and for physical health but perceives them as an integrated whole because one can beneficially feed into the other.
	The hon. Member for Stoke-on-Trent, South (Mr.   Flello) mentioned mental health services for children and adolescents. He rightly said that much good work is being done. However, the charity YoungMinds suggests that the pressures on primary care trust budgets mean that those for community and adolescent mental health services are also under pressure. What reassurances can the Minister give that those groups are being properly looked after?
	Let us consider the other end of the age scale. Many hon. Members will have attended a Mind event entitled "Access all ages" about mental health provision for older people. There is a danger that society assumes that those who are old become "a bit senile" and that mental health deterioration is simply part of getting old. We need to counter that assumption and ensure that we do not take it for granted that older people will have mental health problems.
	This week, the Commission for Social Care Inspection published a report, with which the Minister will be familiar, which found that the management of many elderly people's medication in care homes is inadequate. That will undermine the mental health of many vulnerable older people and I am worried about that.
	The motion mentions the position of those in black and minority ethnic communities, who are more likely to be in hospital with mental health problems, to be sectioned under the Mental Health Act 1983 and to be physically restrained. Do the Government understand the reasons for that and how far it is due to discrimination or different patterns of provisions? What is being done about that?
	Let us consider positive action that can and should be taken. The Minister will have come across the Institute for Public Policy Research report that was published last year on "Mental Health in the Mainstream", which makes several specific recommendations. I shall touch on just a couple of those recommendations. First, the report talks about getting access workers into health services where GPs are inappropriate. What does the Minister think about that idea? How seriously has it been taken over the past few months? Secondly, it considers the use of "non-pharmacological" treatments, therapies and so on, and says that the key is prevention—getting in early, before things get out of hand.
	Before concluding, I want to mention a couple of wider issues. The first has been mentioned already in the debate—the position of people with mental health problems in respect of the incapacity benefit system. It is worrying that the Government are proposing a carrot-and-stick approach: although it is possible that more money will be given to those people who jump through the right hoops when they apply for the benefit, the stick of sanctions might be applied to others. What discussions has the Minister had with the Department for Work and Pensions about the impact on mental health patients who fear that they will lose their benefit if they do not do certain things? What assessment has she asked that Department to make of the impact that changes to incapacity benefit will have on people with mental health problems?
	There are three prisons in my constituency, so I was pleased that the problem of mental health in prisons has been raised. However, if we think that the mental health service as a whole is a Cinderella service, the mental health service in prisons is even lower down the scale. I am pleased that mental health in prisons is now the responsibility of the Department of Health and not the Home Office, but will the Minister say what progress is being made? There have been an alarming number of suicides over the past few years at the Eastwood Park women's prison in my constituency: how much of a priority is that for the Government?
	Finally, mention has been made of the mental health Bill, which has yet to be published. So far in the debate, the Government have said some relatively enlightened things about the importance of mental health, and about prevention. However, that contrasts with the tabloid-driven, draconian, lock-'em-up mentality that seems to underlie the forthcoming Bill. I hope that the Department of Health will take ownership of the Bill and not allow the grubby hands of the Home Office to be all over it. We need a mental health approach to these matters, not the law-and-order approach driven by tabloid scare stories that is inappropriate in the vast majority of cases. Although there is agreement today that we should not stigmatise people with mental health problems, there is a real danger that that is precisely what the Bill will do.
	This a vital and valuable debate. My concern is that the people in GPs' surgeries providing the front-line provision for those with mental health problems are not adequately trained or resourced. As we have heard, mental health services are being squeezed as deficits get shunted around. A key remedy would be to pool resources across different forms of health and social care, so that provision is made for the whole person and the totality of his or her needs. We must not see people only in terms of what is wrong with one part of their lives. That is the more enlightened approach that we in the Liberal Democrat party advocate.

Mr. Deputy Speaker: I remind the House that Mr. Speaker has placed a 15-minute limit on Back-Bench speeches. Given the extra interest in the debate, hon. Members will be doing themselves a favour if they keep well within that limit in the time remaining.

Andrew Smith: I am very pleased to have this opportunity to debate mental health services. As has been noted already, they are enormously important to the lives of service users and their families. It is good to see a measure of agreement across the House that it is important to put the stigma associated with poor mental health behind us, and that the mental health services should get the attention and priority that they deserve.
	Too often in the past, mental health care has been a poor relation, but there is no doubt that the extra money provided by this Labour Government has made a big difference. Although more needs to be done, it is no exaggeration to say that mental health care in Oxfordshire has been transformed over the past nine years. That is thanks to investment, the achievement of NHS staff at all levels and to the work of excellent local community groups such as Restore. The local trust has made great strides in providing better services and more facilities for patients. Tangible improvements are clear for all to see, and patients appreciate the improved standards of care that they receive. A recent survey of the Oxfordshire Mental Healthcare NHS Trust's service users showed that more than three quarters of the respondents rated the standard of their overall care as excellent, very good or good.
	Smart new buildings, wards and facilities have been provided, and more are on the way. Wards at the Warneford hospital in my constituency are being upgraded, extended and refurbished, and the extension to the Highfield unit for young people with mental health problems will open up more places and allow the trust to provide separate areas for boys and girls. More services are being made available. In the past, people with a personality disorder had a choice between hospital and repeated GP appointments. Now, they have access to dedicated out-patient and day-care support.
	My constituents can now receive in-patient care in Oxford for eating disorders, instead of having to be transferred to faraway hospitals. The new forensic pre-discharge service helps people who have been mentally ill and in secure hospital care to take the first steps towards living in their own community again. That is just the kind of gradual supported approach for people going back into the community that patients and the public want to see. Those and other developments, coupled with careful financial management, enabled the Oxfordshire Mental Healthcare NHS Trust to progress from one star in 2003 to three stars in 2005. No praise is high enough for the dedication of the staff at all levels who made that possible.
	Despite all this outstanding work, however, local mental health services face the enormous challenges arising from cuts that are being made to tackle the financial deficit in the Oxfordshire health economy—a deficit, moreover, that was not of their making. My right hon. Friend the Minister quite reasonably gave the House the relevant figures earlier. However, what this means financially for Oxfordshire is that, whereas in 2004–05, Oxfordshire Mental Healthcare NHS Trust spent £51.2 million and budgeted £53.7 million to meet this year's expenditure, it is now being asked this year to cut £1.1 million from its spending, even after having received £1.5 million one-off help from the strategic health authority, which it may yet have to repay over the next two years. All in all, the trust has almost 10 per cent. less than it says that it needs to meet service and cost pressures. We can argue about these figures—and about what proportion of them represent legitimate efficiency gains, and so on—but however we measure them, the cuts are damaging to the trust and its services, and deeply worrying for patients, their families and staff, as the many letters that I have received from my constituents make clear.
	What this means for services is that the trust is having to look at bringing forward the closure of in-patient beds, leading to a real rush to put in place the 24-hour crisis community cover that is needed. It would have been much better to plan and carry through such a change in a measured way. The trust is also having to consider the closure of the psychiatry liaison service at the John Radcliffe hospital, which provides support in the accident and emergency unit to people who have attempted suicide and which also supports people in acute beds who are suffering from chronic illnesses such as cancer. The trust is also considering the closure of an in-patient unit for older adults where patients are assessed for depression and Alzheimer's disease. It is also now unable to invest sufficiently in support for older people in the community or to ensure that early intervention is available to help young people at the first onset of mental illness.
	The seriousness of the position is compounded by cuts in the Supporting People programme budget locally, as well as by the current state of NHS funding mechanisms, which is a more general problem for mental health care trusts. Whereas additional work for other acute hospital trusts is funded according to the national tariff, additional work at mental health care trusts has to be absorbed within the block allocation, which puts skewed pressure on their share of overall expenditure. This makes it more important that we all speak up for the needs of our mental health care services, both here and in our constituencies, so that they do not get squeezed out by competing demands.
	All of that poses a real danger of damaging and obscuring the excellent progress that has been made in mental health care locally and nationally. However, it also puts a question mark over exciting developments planned for the future in preventive community provision in partnership with social services, round-the-clock community crisis support, the development of the complex needs service and the pre-discharge unit for mentally ill offenders, which addresses the issues raised by the hon. Member for Northavon (Steve Webb).
	To build on what has been achieved rather than put it at risk, and to make the most of opportunities to improve mental health care in our community, I urge Ministers to consider again what can be done to ease the financial pressures in Oxfordshire, particularly in the mental health care trust, even now in the remaining weeks of the financial year. The mental health care trust is working with the rest of the local NHS to address the underlying financial problems that affect services in Oxfordshire. However, a more measured view needs to be taken of the trust's ability to bear the funding cuts, considering that it has a high proportion of vulnerable service users, many of whom are in no position to speak up for themselves.
	In addition, given the body blow that services have suffered this year, Ministers need to assure us that they are taking action to avoid any repetition of this financial fiasco next year, and that budgets across PCTs and hospitals will be properly planned so that those in mental health and other services in the NHS can look ahead with confidence and work with patients and their families to make the most of the huge extra investment that this Labour Government have made and continue to make in the NHS. That has made a terrific difference to the quality of care available to patients and the wider community locally. Let us keep up that good work and carry it forward, not put it at risk as has sadly happened this year.

Stephen Dorrell: Like others who have spoken in this debate, I congratulate my right hon. and hon. Friends on the Front Bench on providing Opposition time to debate mental health services. Constant improvement in the services delivered to mentally ill people is a core responsibility of the national health service and my right hon. and hon. Friends on the Front Bench are entitled to credit for providing time for the House to debate those important issues.
	If I may paraphrase the speech of the right hon. Member for Oxford, East (Mr. Smith), it is fair to say that he argued that the Government have provided substantial extra money to the national health service, which is true, and that that has made possible significant improvements in services to mentally ill people, which is also true. However, difficult issues remain for those responsible for managing those services locally. Whatever level of resources is likely to be provided to the national health service, difficult choices remain to be made about the pattern of delivery of local services. That relates directly to the point made by the hon. Member for Northavon (Steve Webb).
	The Minister does neither herself nor her Government any credit when she seeks to persuade us that, before 1997, there was a dark age in which no progress was made on any of those issues, and that there was suddenly a new dawn on 1 May 1997 when all requirement for choices was removed. That is not a vision of events that will be recognised by those who work in the mental health services of the national health service. It seems much more accurate to say that the direction of mental health services has been consistent under Governments of all political complexions since the days when Enoch Powell was Health Minister and first committed the national health service to the policy of taking mental health services out of the Victorian institutions and providing proper, high-quality, community-based care for mentally ill people.
	We all know that the story of the changes in mental health service delivery over the intervening 40 years has been one of individual local successes and failures, but it is surely true to say that, throughout those 40 years, Ministers of all political complexions have been committed to broadly the same vision of the future of mental health services. If we acknowledge that, we shall be able to engage in a much more mature and adult debate on the issues that we face in delivering what is a broadly shared agenda.
	Various speakers have rightly sought to avoid the phrase "Cinderella service", which is generally applied, almost by default, to mental health services. I believe that it emanates from the wrong train of thought, because it implies that mental health service delivery in the NHS is somehow different from, or separate from, all other NHS health care delivery. In my view, the similarities between the priorities involved in mental health care delivery and those involved in physical health care delivery are more important than the differences.
	As the hon. Member for Northavon pointed out, the great majority of mental health service delivery through the NHS takes place via community and primary health care services. Exactly the same applies to the rest of health care delivery in the NHS. Mental health services are an integral part of the delivery of health care to elderly people. He was right to say that we should not imagine that all elderly people need mental health services, but we cannot think of mental health service delivery without thinking of it in the context of delivery to individual patients, many of whom are elderly and many of whom suffer from physical illnesses that are complicated by the presence of mental health problems.
	The hon. Gentleman was also right to stress the importance of the interface between social care and health care delivery. If we are to deliver high-quality, successful mental health services, we must bear that in mind. Any multidisciplinary team responsible for delivering mental health care in the community must include both a health care and a social care element. Throughout those 40 years, too many failures could be traced to their roots in the breakdown of communication between health care and social care delivery. As he said, that remains an institutional issuethat Ministers—those responsible for policy development—have not yet cracked.
	Mental health services are sometimes represented as being driven by a mysterious political orthodoxy under the title "care in the community". That was mentioned earlier in the debate. It surely cannot be stated too often that caring for people in the community, whether they are mentally ill or physically ill, is not a manifestation of political correctness, nor is it the manifestation of a Treasury-driven desire to close hospitals and get people into the community, although it is sometimes represented as such. In fact, it represents the central purpose of all health care. Why do we have health care in our society? Surely its purpose is to enable people, as far as is humanly possible, to live their lives normally. That is why community health care, whether it is delivered to the physically ill or to the mentally ill, must be at the heart of the development of health care delivery generally.
	The priorities in the development of mental health services are thus very similar to the priorities in the delivery of the rest of health care. For instance, they relate to the development of primary and community-based care. I welcome the Government's White Paper on the subject, published at the beginning of last week. There is almost nothing in the White Paper that I could not have envisaged writing as the Secretary of State for Health 10 years ago. I observe without rancour that it is a pity that we have gone on such a long detour to get back to some of the ideas that we were developing 10 years ago, most notably and obviously what we used to call GP fundholding and what the Government now call practice-based commissioning. There is no difference of principle between the two and it is a pity that we have lost 10 years in the development of that important idea.
	I ask Ministers to reflect, in the context of the delivery of mental health services, on the implications of the recent changes in the GP contract for access to primary care services at evenings and weekends. All studies of mental health service delivery emphasise the importance of people at short notice being able to secure access to services, particularly young people in the acute phase of mental illness and elderly people who have a short-term requirement for respite care. Now in our communities, Tesco and Sainsbury's are open all through the weekend, but our primary health care delivery facilities are more difficult to access than they used to be. That is an issue for health care across the field but it is a particular issue in the delivery of mental health services.
	I ask Ministers, too, to reflect on the need to ensure that there are properly integrated community-based health care services, including not only social care, but residential care for those who are in an acute phase of schizophrenia and psychotic illness and residential care for those requiring respite care. We all know that, if we are going to deliver successful integrated care in the community, there will have to be proper patient plans—pathways of care—that integrate the different elements of the service.
	What we look for from Ministers is a clear commitment that the Government recognise that there is no difference of view in any part of the House about the type of service that we want to see delivered. Nor is there any difference about our commitment to see resources grow year by year, as they have for 50 years in the NHS, to support the growth and improvement of the delivery of those services. What we have to see is detailed planning locally to avoid the ups and downs in the delivery of service, which were described by the right hon. Member for Oxford, East, and integrated delivery of care, so that, from the perspective of the patient, the service is more reliable, and of better and more consistent quality than we have seen in the past under Governments of all political persuasions.

Diana Johnson: For three years, I was a member of the Mental Health Act Commission. I visited patients not only to check that they were legally detained under the Mental Health Act 1983 but to talk to them about their concerns. With that experience, I am pleased to be able to say a few words this afternoon.
	Although as a Mental Health Act commissioner I was working at the acute end of mental health, dealing with people who were detained, it was interesting to talk to them about their pathways and how they ended up being sectioned. I visited not only NHS psychiatric facilities but private sector facilities. That was an interesting experience because, in some instances, the private sector can provide good facilities and meet needs where the NHS cannot.
	The right hon. Member for Charnwood (Mr. Dorrell) mentioned that the view seemed to be that, prior to 1997, things were terrible and that, from 1997, suddenly things got a lot better. The focus on mental health services has increased since 1997. The investment has gone in since 1997. When we talk to the community and voluntary sector, it says that the joined-up thinking and the investment in mental health services in local communities has been staggering in some instances. From my right hon. Friend the Minister, we heard that there are 8,000 more psychiatric nurses, 1,200 more psychiatric consultants and 3,000 more psychologists. Those are real people providing a real service to our constituents with mental health problems.
	The most important thing that Labour has done is the 1999 national service framework on mental health services, which set the gold standard for what we should be looking to achieve in all our mental health services. I want to talk about child and adolescent mental health services, women patients in mental health services and the NHS estate in terms of psychiatric units.
	On children and young people, on Friday I went to a meeting of the Humber mental health trust, a three-star mental health trust that does excellent work. It said that, although the national service framework for adult mental health services—it includes sections involving children—was a good start, we needed an NSF for young people. The chief executive said that the split between children and adolescent mental health services that goes up to 16 or 18 years of age was not providing the kind of care we should be providing for young people. We need a service that spans the age group from, say, 15 to 30.
	We need to make sure that, for younger children who may come into contact with mental health services, their contact is community-based. We must keep young people away from the acute sector because it is not an environment where we want children and young people to enter unless there are extreme circumstances. The facilities are not suitable for them. There are some disturbed people in our facilities and we need to keep our focus on the community setting.
	Getting in early is important. I was pleased to see that Sure Starts were putting emphasis on developing emotional well being in the support that they are providing to parents and carers of our youngest children. Such guidance to those who look after children uses creative activity to improve children's self-esteem, social skills and emotional well being. That is absolutely right. It is a stark fact that a child living in a low-income, lone-parent household is twice as likely to have emotional disorder as a child in a two-parent family on a reasonable income. There is a clear link with poverty and it is right that Sure Starts, which were based on the most disadvantaged areas, are putting the focus on emotional well being.
	I want to talk about Mind, which provides excellent services across the country for people with mental health problems. In my constituency, the Linx project provides help with housing and independent living for young people who have shown the first signs of psychosis. Getting in early and investing early in our young people means, we hope, that they can go on living independent lives and putting their problems behind them.
	We have heard about the massive investment in PCTs for mental health services and it is worth putting on record that £300 million has gone into PCTs and local authorities to improve child and adolescent mental health between 2003 and 2006. However, there are still some gaps. I visited Hull domestic violence refuge and was told by some teenagers that there were counselling facilities available to younger children to help them deal with the trauma they had experienced, but that there was nobody to provide teenagers with counselling. I hope that we put some work into that area. It may be that we invest now to save later on.
	I want to pay tribute to the work done in Scotland in the one in four campaign, which is trying to remove the stigma from mental health. Hon. Members will agree that that is a good campaign. In Australia, the National Youth Mental Health Foundation has been set up and is looking to make sure that money is put towards young people suffering mental health problems. We need to ensure that particular resources are attached to making sure that those in the 12 to 25 age group get the help they need. Of course, the recently published Health White Paper will work to counteract the stigma of mental health.
	I turn briefly to safety, which is a real issue for women in-patients in mental health facilities. As was pointed out earlier, there can often be a mixture of people with various mental illnesses and disorders on a given ward. It is important that women, who can often be very vulnerable, are provided with separate facilities. We have a commitment to providing gender-specific facilities and I hope that more resources will be put into providing them throughout the country.
	We also need to consider the estate. Statistics show that only 35 per cent. of psychiatric intensive care units have en suite facilities, that 25 per cent. have no enclosed garden space and that 35 per cent. have no gender- specific facilities. We need to get these issues right. A decent standard of accommodation can have a very positive effect on the recovery of those suffering from mental illness or disorder. I am pleased to note the massive investment that has already gone into improving in-patient facilities, but there is still more to do.
	I am pleased that we have made a positive start and it is indeed since 1997 that we have really focused on this issue. We need to keep working on provision for children and young people, because there is more to do in that regard. As part of our wider public health agenda, we need also to deal with the issue of emotional well-being throughout an individual's life.

Angela Browning: During this debate, which I very much welcome, we need to reflect on the scale of mental ill health. We are told that one in five adults will experience mental health problems at some point in their life, which means that, of the 20 Members currently in this Chamber, four of us could well experience such problems. It is very unlikely that the same ratio of Members will experience any other type of health problem.
	As with many other conditions, mental ill health does not affect just the patient. The impact on families, particularly the prime carer, is enormous; indeed, it is so great that, ultimately, it can affect both their mental and physical health, particularly if that patient has a long-term condition. Many of us—certainly me—have experienced at first hand in our families the agonising condition of mental ill health and its impact on people's lives. It is one of the most distressing conditions.
	In discussing mental health, I want to focus on the two age extremes. Many Members have mentioned young people, and at that age suicide is an issue. The Mental Health Foundation and Mind have pointed out that the highest rate of suicide is among young men between the ages of 15 and 24, that 20 per cent. of all deaths among young people are through suicide, and that one in 10 of 11 to 25-year-olds self-harm. Given the scale of the problem, we have to find the answers and the policies to alleviate it. Behind those bare statistics are very real tragedies for the families concerned.
	It would be remiss of me not to add one more statistic on behalf of a group of people whom I mention probably far too often in this House. However, I make no apology for doing so. A recent report by the National Autistic Society pointed out that the attempted suicide rate among adult sufferers of Asperger's syndrome is 8 per cent., which is very high indeed. When we consider, in managing such patients, how they reached the point of attempting suicide, there is usually—not always, but usually—an identifiable pathway in their relationship with the statutory services.
	In the recent past, I have had more than one Adjournment debate on in-patient deaths within the Devon Partnership NHS Trust. I wish to put on the record that since I have raised the issue and some of the concerns have been addressed, we have seen—under the management of Mr. Iain Tully and his team—a real rethink on why those tragic deaths occurred in our area. The mother of one of the young men who died showed me a plan of his relationships with statutory services during his long history of mental ill health. The relationship usually started well, but eventually failed. We euphemistically call that falling through the net, but too many young people do so—especially in their relationships with community services.
	I wish to pick up a point made by the hon. Member for Northavon (Steve Webb). Often, the first professional a patient sees is their GP. I sympathise with GPs because they have an eight-minute slot in which to listen, assess and decide what to do. There are GPs in my constituency—and I am sure they are not unique—who ask how they can do anything other than pick up the prescription pad at the end of the eight minutes. A prescription may solve a short-term problem, but—and I mean no disrespect to GPs—it does not address the underlying cause. Many of the young people who end up as suicide statistics do so because not enough time has been spent with them, there has not been enough continuity in their care and the people who could help are not out there in the community.
	My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) pointed out that when people break their legs, they recover. Well, people do make full recoveries from certain types of mental illness, but mental health problems make people fragile. Such problems are often recurring. Also, when people present to GPs and other professionals, their instinct is often to conceal the underlying problem. It often takes many hours of discussion and counselling before even the best trained psychiatrist can start to identify the right approach for an individual. It is time-consuming, painstaking work that is very different from other areas of medicine. Therefore, while I understand the Minister's wish to put the statistics in the best light possible, we still have a huge way to go. The suicide statistics prove that.
	At the other end of the age spectrum are the elderly. The mental health of many elderly people breaks down from a simple cause—social isolation. To put it more simply, the cause is loneliness. Many elderly people who are unable to get out and about, or whose family and friends have started to die off or have moved away, spend far too many hours on their own, and that inevitably leads to depression. As we know, depression is a spectrum. It can be intermittent and addressed by medication, but all too often it leads to more serious mental health problems. Depression is also a common side effect of other physical conditions, such as Parkinson's disease. It is extremely difficult to disaggregate the depression and the underlying mental health problems from the physical conditions in elderly people who are often not able to be very good self-advocates. I can think of some of my elderly relatives who always put on their best face when the doctor came to call—a natural response for that generation—even though they had problems that the doctor needed to know about. It is a complex and grey area, which is not easy for professionals, let alone politicians, to enter.
	More than 13 per cent. of the NHS budget is devoted to mental health services and I am concerned about care in the community. We have heard much about the packages to deal with people's physical needs, but if we are to move towards more people being cared for at home for longer—as we certainly are in Devon— especially when they are extremely dependent physically, their emotional and psychological needs must also be met; otherwise, many elderly people will develop serious mental health problems. All too often when serious problems occur, whether with younger people in suicide cases or with elderly people with mental illness—the health service has to respond to a person in crisis. The statutory services have to respond suddenly to situations where, to put things in crude financial terms, much more money will have to be spent than if there had been regular, lower-level interventions at an earlier stage.
	There is a dilemma. Health authorities and social services departments work on annualised budgets and the system mitigates against such regular interventions. It has to deal with people who are in crisis, so it is easier to pare off services and facilities that may be regarded as low level, even though they might have ensured that many people who appear in the crisis statistics had a better quality of life and did not succumb to mental illness. The fact that more people have been admitted to mental hospital since the implementation of the Mental Health Act 1983 is an indication that intervention takes place only when there is a crisis. We must address that issue. Crisis management is never the most effective outcome, for either the patient or the system.
	As I said earlier, I served on the scrutiny Committee on the Mental Health Bill, so it would be remiss of me not to mention my grave concern about two aspects of the Bill; indeed, the Minister would expect me to do so. I still believe that the Government's broader definition of mental disorder is wrong and if the Bill is introduced I hope to put my case to the Minister even more robustly than in the past. I urge her to reconsider that aspect of the Bill.
	My second concern relates to compulsion. We received evidence from the Royal College of Psychiatrists that, under the provisions, we should need to detain one in 2,000 people with no previous indication that they would cause severe harm. I realise that the proposal came from the Home Office rather than the Department of Health, but if we broaden the definition of mental disorder so that it is based not on clinical diagnosis but merely on behaviour, and if that is accompanied by wider provisions in civil legislation for indefinite detention, the infringements of civil liberties that we have discussed in this place in the past will be as nothing by comparison. If the Minister does not address that aspect of the Bill, the rebellion will not be merely in this and another place; people will march in the streets.
	I urge the Minister to reconsider those two fundamental rights, on both of which the scrutiny Committee made firm recommendations. Together, those two aspects of the Bill will be a huge infringement of civil liberties.

Meg Hillier: My hon. Friend the Minister said that we need a response that stretches right across Government, and I want to address my brief comments in today's short debate to some of those issues. Last Thursday, I had the pleasure of opening an art exhibition by the Yao Yao group—a social group organised by the Chinese Mental   Health Association, which is based in my constituency—and it was one demonstration of the fact that there are many ways to tackle mental health problems, not just through the health service.
	I pay tribute to the many people and organisations in Hackney, South and Shoreditch and Hackney as a whole—such as Mind and the Chinese Mental Health Association, which put time and effort into supporting people with mental health problems—as well as the people with mental health problems who also play a key role. My hon. Friend knows of the good work done at Homerton university hospital and by City and Hackney Mental Health Trust. It is important that all those organisations play a big role in a constituency with a high incidence of mental health problems.
	I will not bombard the House with statistics in the short time that I have, but it is startling that admissions to hospital for schizophrenia are three times more common in Hackney than in England as a whole, for both men and women. I want to touch very briefly on three issues: employment, ethnicity and the impact on welfare benefits for people suffering from mental health problems. The hon. Member for Northavon (Steve Webb) rightly highlighted the need for preventive work. He said something about the Minister suggesting that everything in the garden was rosy. In some ways, I agree with him. Not everything in the garden is rosy, but it is a lot better than it was, which is a good step.
	General practitioners in Hackney are very much at the sharp end of dealing with people with mental health problems. Other hon. Members, particularly the hon. Member for Tiverton and Honiton (Angela Browning), have highlighted some of the difficulties of dealing with mental health problems in the short time that many GPs have available. That is one of the reasons why I welcome those aspects of the health White Paper that will improve and promote community care provision at that initial presentation point.
	We all know that people with mental health problems have much more difficulty finding employment than the general population. That is so even when compared with people who are physically disabled. About 16 per cent. of physically disabled people are more likely to be unemployed, compared with 50 per cent. of people with mental health problems. Some 86 per cent. of people with longer-term mental health problems are unemployed. The other side of the coin is how employers react—only 37 per cent of them are prepared to consider employing people with such difficulties.
	I am very proud that the two local mental health trusts—East London and the City, which covers Hackney, and North East London—the local strategic health authority and South Bank university have joined forces to fund a consultant occupational therapist for employment. I hope that my hon. Friend agrees that that is the sort of joined-up government to which she referred in her comments. The two mental health trusts have adopted a joint partnership approach—the roots to employment project, which is the first of its kind in the UK to help people with mental health problems into work, by working with employers to ensure that they address the issues and understand the need to help people with mental health problems back into the workplace.

David Drew: Does my hon. Friend agree that although people may expect this not to be the case, some problems exist in the public sector with regard to attitudes to mental health problems? I have taken up such cases, and it has always been more difficult to get someone who has had a breakdown back into public sector employment than into the private sector. Will my hon. Friend say something about that?

Meg Hillier: My hon. Friend may have a point. I cannot draw on enough experience of people bringing such issues to my surgery—I am only a new Member compared with him—but I am proud to see what happens when I go to forums in Hackney. For example, I opened a Jobcentre Plus office at the end of last week, and some of the employers there, including Hackney council and the local hospital, recognised the need to support people with mental health problems. They work positively with those people and take on board their problems. Perhaps that happens because we have the roots to employment project in Hackney, and perhaps my hon. Friend may wish to raise that with the primary care trust, the mental health trust and the other health and employment bodies in his constituency.
	I said that I was going to touch on ethnicity. Hackney, South and Shoreditch is especially affected by the Eurocentric nature of much psychiatric training, which helps to contribute to the fact that Afro-Caribbean people are typically three to five times more likely than white people to be admitted to hospital with a first diagnosis of schizophrenia, and then 10 times more likely to be diagnosed as schizophrenic. The Chinese Mental Health Association has much of interest to say on the subject. The Chinese community in Britain is often isolated and many Chinese people do not wish to talk about mental health problems for cultural reasons. Problems due to language affect not only the Chinese, but other groups across the board.
	I am delighted that north-east London is one of 17 nationally focused areas for delivering race equality in mental health. The Government have taken a major step forward by recognising the white Eurocentric approach to psychiatry. Such initiatives are sorely needed and much welcomed in Hackney. When I spoke to Hackney Mind, I found that many mental health service users were especially pleased that the scheme was moving forward, but we need to see results on the ground. We are only at the beginning with the scheme, but I am sure that my hon. Friend the Minister will keep a close eye on the situation from Whitehall. As other hon. Members have said, the crux of the matter is what happens locally, so local providers need to make changes.
	When I said that I would be brief, I meant it in all sincerity, but I want to touch on incapacity benefit, as did the hon. Member for Northavon. Hackney, South and Shoreditch has the second highest number of incapacity benefit claimants of any London constituency—only Regent's Park and Kensington, North, which is in west London, has more. My constituency, which nestles close by the City and runs right down to Liverpool Street station, is 31st equal nationally for the number of claimants. We have 7,400 claimants, 63 per cent. of whom are under 50. We are working locally to probe the matter more closely, but we know that there is a big overlap of people on incapacity benefit and those with mental health problems.
	I echo the hon. Member for Northavon in hoping that my hon. Friend the Minister is talking to her colleagues in the Department for Work and Pensions to ensure that my concerns, which are shared by Hackney Mind and local health providers, are being tackled. As we make important and welcome changes to incapacity benefit, we should not lose sight of such a difficult issue. I hope that my hon. Friend is joining up with her colleagues in the DWP as part of the joined-up Government that she mentioned.

Tony Baldry: I was sorry to hear about the Secretary of State's illness, not least because all six Oxfordshire Members are due to meet her at 12.30 pm tomorrow to discuss the freefall of the NHS in Oxfordshire. My right hon. Friend the Leader of the Opposition, my hon. Friends the Members for Wantage (Mr. Vaizey) and for Henley (Mr. Johnson), the right hon. Member for Oxford, East (Mr. Smith) and the hon. Member for Oxford, West and Abingdon (Dr. Harris) will all be extremely disappointed if the meeting does not go ahead, so we wish the Secretary of State Godspeed for a quick recovery.
	The Minister said that mental health was one of the Government's top three priorities, but I hope that the House will not consider me churlish when I say that I increasingly think—perhaps I have one of the problems to which my hon. Friend the Member for Tiverton and Honiton (Angela Browning) referred—that I am living in a parallel universe, because there is a world occupied by Ministers and many others, and the world in Oxfordshire. As the right hon. Member for Oxford, East indicated, Oxfordshire's mental health services are confronted by a series of interrelated problems.
	The primary care trust wants the Oxfordshire Mental Healthcare NHS Trust to save £1 million. Additionally, the strategic health authority is requiring the trust to save a further £5.3 million over the next three years to break even and has imposed a cut of £1.7 million on top of that, not because the trust is in any way overspent, but because the rest of the NHS in Oxfordshire is overdrawn. The SHA thus imposed an implied deficit of £1.7 million on the trust to make up for overspends in other parts of the NHS.
	In addition to all that, there has been a reduction of at least £400,000 in the Supporting People budget, which I have raised in the House on a number of occasions. The sum of all those interactions is that the cuts represent about 10 per cent. of the mental health care trust's budget for patient care and at least 15 per cent. of the money for supported housing, which is likely to have a devastating impact on the lives of people affected by mental illness and the people who care for them.
	To put that in context, I can tell the House that Dr.  Fergusson of the Banbury branch of the Alzheimer's Society has written to everyone he can write to, because he feels, quite rightly, that the closures
	"are scandalous on a number of counts".
	People involved in mental health care in Oxfordshire feel desperate about this. As the right hon. Member for Oxford, East said, over the last few years the mental health care trust has gone from having one star to having three stars. We started to feel that people were getting a grip on the service. It has now gone into freefall again, and we are seeing the closure of older adult psychiatric day hospitals, which, in the words of Dr. Fergusson,
	"directly targets health service provision for one of the most vulnerable groups in society, who are unable to protest".
	The Fiennes day hospital in Banbury is a centre of excellence where, Dr. Fergusson says,
	"a very competent and committed staff team have, over recent years, transformed local perceptions of Older Adult Psychiatric Services. This team should be held up as an example, not destroyed."
	He is also concerned that a number of the closure decisions were taken—I can confirm this—in the mental health care trust before public consultation had even begun. In one or two cases, such as that of the Fiennes adult day hospital, the staff heard of the closure in briefings, not in a consultation document, and before any member of the statutory services, myself or anyone else. That is not acceptable.
	There are three issues that I want to mention to Ministers. First, in the overall context of NHS spending, if there is a squeeze on spending, mental health seems to take a disproportionate share of it. I see no reason why the strategic health authority has arbitrarily imposed a £1.7 million implied deficit on the mental health care trust.
	Secondly, we are moving into a world of payment by results. There has been no real discussion about that this afternoon. I do not see how payment by results will work with NHS mental health care funding. There has to be an alternative system to ensure that mental health work is properly funded in future; otherwise, there will be real tension. I am not confident that GP practice-based commissioning will ensure that mental health trusts in Oxfordshire and elsewhere are properly funded.
	I turn to my last point about the squeeze on mental health care work. In the acute sector there is a reasonably clear divide between work done by the NHS which is free at the point of use in the NHS and funded by the NHS, and work done as part of social care, which is means-tested and provided by social services. Often there is a black hole, and there is a debate about where the line should be drawn, but there is a reasonably clear line. When it comes to mental health care services, that line is much more blurred, so the mental health care trust ends up carrying up many more services, such as those under the Supporting People budget. There is a much greater tension there, and people expect the trust to deliver those services.
	I am sure that the Minister genuinely believes that this is one of the Government's three priorities. She and her colleagues are very welcome to come to Oxfordshire, because I am not being flippant or frivolous—I increasingly believe it—when I say that we are living in a parallel universe there. It may well be something to do with its being a comparatively small county with a large teaching hospital and a major centre of research. Something is causing a problem when we have an NHS in freefall, but the effects are being felt particularly by those with mental health problems. That is not fair and it is not reasonable. It is not good news for the Minister, because for every success story that she can trumpet, "G2", the New Statesman and the rest of the media can focus on a failure. Although NHS mental health care in Oxfordshire is not a failure, the situation is in freefall; it should not be, and it needs to be addressed.

David Howarth: Mental health will certainly be one of the big issues of the 21st century. Placing greater emphasis on mental health is one way in which the Government can improve the well-being of individuals, but I have to say that the complete opposite is happening in my constituency. I hope that the House will forgive me if I confine my remarks to what is happening in Cambridge, because it is such an extreme example.
	Despite what the Minister says, mental health services in Cambridge and south Cambridgeshire are in crisis. The overall budget has been cut by £2.75 million, which is 13 per cent. of the total. Two rehabilitation wards are being closed; an acute in-patient ward is being closed; three adult day care centres are being reduced to two; a ward for older acute patients is being closed; and arts therapies, physiotherapy and electroconvulsive therapy between them have to save £150,000. Other services are still under threat, including the young people's service, which the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned. We still hope to save that service; the decision has been deferred and we are trying to persuade the primary care trust and the mental health trust that it would be more expensive in the long term to make cuts now, because of the excellent preventive work that it does.
	The PCT, echoing the Minister, claims that closure of acute wards will be offset by the reorganisation of community services and investment in assertive outreach work. The trouble is that the PCT is requiring £2 million of cuts not next year but in the current financial year. There is no lead-in time to get the community and crisis resolution teams fully in place. I fully accept that crisis resolution and community outreach are a good way to run mental health services, and preventing in-patient admission has to be a good idea. However, if there were no financial pressure, the change would have been brought in over a much longer period.

Tim Farron: My hon. Friend may be aware that in my constituency the hospital trust is to lose £500,000 because the primary care trust is trying to save the same sum by closing two wards in Kendal. The pressure, of course, is on the PCT to balance its books; the reality is that the NHS overall loses out. If we look at those entities as separate organisations, not as a single national health service, we do not have sensible joined-up government. I wonder whether that experience is reflected in my hon. Friend's area.

David Howarth: That is a common pattern throughout the country where there are problems.
	In normal circumstances, as I say, one would set up the new teams first, look to their effect on admissions and then perhaps reduce the number of beds. In some places, when an assertive outreach service is set up, the teams find unmet need, so the need for in-patient beds goes up, not down. In Cambridge, the change is happening all at once, and risks are being taken with patients' welfare. The whole thing resembles tightrope walking without a net.
	The mental health trust is, of course, acting under duress from the PCT. The PCT has little choice because of the dire state of its budget. The Department of Health requires a £15 million reduction in spending, and even that does not cover the current deficit. Another £23 million deficit is on the way in subsequent years. Ministers keep saying that vast sums have gone into the NHS. In written answers to me the Minister has said that Cambridge PCT is receiving 29 per cent. extra, and that even after the cuts Cambridge's spending on mental health will still be above the national average.
	We need to tackle those points directly. There has been an increase in funding, but as the hon. Member for Banbury (Tony Baldry) said, one of the problems is that if there is a foundation hospital, the PCT's cheque book is, in effect, handed over to that hospital, which writes itself cheques that deal with all of its previous financial problems. Effectively, the financial problems of the acute trusts have been transferred to the PCTs, and the PCTs have had to remove the budgets of what remains under their control—mental health and other services. When the mental health trust acquires the right to charge at tariff rates for the patients who cross its threshold, its problems may be solved in the same way as those of acute trusts, but what then will happen to PCT budgets and GP fundholder budgets?
	On national averages, the point is not the average but the need. In October and in meetings with Ministers I raised several problems about the green book—the index of mental health need. The measure of poverty that the green book uses is based on benefit take-up, not income. For Cambridge that is catastrophic, because successive Governments have taken away students' right to benefits. Students have serious mental health needs, as the hon. Members for North-West Leicestershire (David Taylor) and for Tiverton and Honiton (Angela Browning) said. Suicide rates are high and self-harm is a problem. I should add to that—I know this from experience as a university teacher—the problem of eating disorders, which I have seen blight the careers of several brilliant young women.
	The second point about the green book is the measure of housing condition rather than housing tenure, despite the fact that all the academic work shows that the link with mental health problems is with housing tenure. The third and most important point for us is that the needs index reduces funding if one's area is near a good mental health institution, such as Fulbourn hospital. The reason for that is the cost of reaching the facility, but in reality being near a good facility increases the number of patients in the area, because of migration and because people stay in the area once they return to the community. The Secretary of State conceded that some work needs to be done on these matters, and I will be glad to hear what further work has been done.
	The cuts in mental health services in Cambridge have had at least one good effect: they have brought the community together in opposition to them. Thousands of people joined the public protests, attending meetings and vigils against the cuts. That in itself has helped to reduce the stigma attached to mental illness, which several hon. Members have mentioned. Despite all the brave and good things that people have done—including, in a live BBC radio interview, the interviewer mentioning to me that he had suffered from mental illness and had recovered—the campaign that we are waging is not just to change public attitudes but to get more funding. That is the problem that we face. I gather that today the county council's health scrutiny committee is meeting, and it has the power to refer the issue to the Minister. I very much hope that it does so. Then we shall see the strength of the Minister's commitment to mental health.

Jeremy Wright: I agree with comments by Members on both sides of the House that the primary difficulty with the mental health debate is that various types of mental illnesses are minimised and often ignored. Within that broad category of mental illnesses, there are some that are disregarded even more than others. I want to focus my remarks in the brief time available on one of those: post-traumatic stress disorder.
	Post-traumatic stress disorder is a mental illness that is often dismissed, not simply by the rest of us but by those who suffer from it. It therefore presents its own specific difficulties in terms of the work that the Government and the NHS must do to support those who suffer from it. People have always suffered from it, but it has only relatively recently been recognised—from first world war shell-shock to the illness that is diagnosed today.
	Post-traumatic stress disorder can affect us all. Whether we are holidaymakers or commuters, we are potential victims of post-traumatic stress disorder as a result of natural disasters of almost biblical proportions or terrorist atrocities on our daily commute to or from work. It particularly affects—this is the group of people to whom I particularly want to draw the attention of the House—those who feel that they ought to be most able to deal with it, and are therefore least likely to seek help. I refer to those in the armed services and the emergency services. Those who serve this country bravely, and sometimes at great cost to themselves not only physically but mentally, suffer from anything ranging from flashbacks to serious mental breakdowns, and do so often in what might be an unsympathetic environment.
	There is no doubt that post-traumatic stress disorder, like other mental illnesses, wrecks lives—not just the lives of those who suffer from it but those of their families and friends. It often leads to alcoholism, violence, homelessness and family breakdown, and all those problems need addressing in the context of the illness that the person is suffering from. The illness is costly not only in human terms but in financial terms.
	I recently met an experienced firefighter who, as a result of a collision with a car in which the driver of the other vehicle was killed—an incident that was not the firefighter's fault—suffered a series of flashbacks leading to a more serious breakdown, after which he spent six years away from work. That cost the taxpayer a total of £118,000 in pension, incapacity benefit and other benefits. On that basis it must be right that in framing their Mental Health Bill, the Government give clear and full consideration to the ways in which we can assist those individuals and ensure early intervention, so that they can receive the care and treatment that they need as soon as it can be given to them.
	I hope that the Minister accepts that although one option for those individuals when their illness becomes very serious is in-patient care—I am sorry to say that in-patient facilities for military personnel have closed progressively over the past few years, both at Catterick and Ty Gwyn in north Wales—other options include counselling and therapy, which should be available through the NHS but so rarely are. As I understand it, there are only 14 locations where counselling can be given to those who suffer from post-traumatic stress disorder. The gap must be bridged by the voluntary sector. In fact, it is bridged very successfully by such groups as Assist, in my constituency, which does a fantastic job in trauma management. I invite the Minister and all those involved in drafting the mental health Bill to consider what can be done to weight the services available to those who suffer from post-traumatic stress disorder in favour of therapy and access to counselling, either in person or by telephone, in order to ensure that people have early access to support, which they, and we, will find valuable.
	The firefighter to whom I referred calculated the costs to the taxpayer of his six years' absence from work. He has recently felt able to return to work, and has done so, as a result of counselling provided by Assist which cost £1,000. The Government could profitably consider such approaches to looking after those who have served us so well and ensure that they receive the care and support to which they are fully entitled. All Members will rightly express outrage when members of the armed services and the emergency services who have suffered serious physical injury do not receive the care to which we and they believe that they are entitled. It is surely right that those who suffer mental injury as a result of the same activities on our behalf should receive similar consideration.

Tim Loughton: We have had a good debate. We are disappointed that the Secretary of State was not able to join us and we wish her a speedy recovery, but it is always a delight to have the Minister of State, Department of Health, the fragrant hon. Member for Doncaster, Central (Ms Winterton) giving her speeches, even if she did go on a bit.
	The debate has been well informed, well mannered and civilised, although it has been dominated by Oxbridge—over half the speakers represented Oxfordshire or Cambridgeshire constituencies. Contributions ranged from that of my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright) on the important subject of post-traumatic stress syndrome to those of the hon. Member for Kingston upon Hull, North (Ms Johnson), with her expertise as a Mental Health Act commissioner, and my right hon. Friend the Member for Charnwood (Mr. Dorrell) with all the great expertise that he brings.
	It has been a good debate, but primarily it has been good to have a debate because we have not had one on the subject for more than eight and a half years, despite the fact, as everyone has acknowledged, that the subject is extremely important and affects so many of our constituents. We know that one in four people will suffer some form of mental illness in their lives—people from all backgrounds—and one in 10 school-age children will be affected by some form of mental illness. The hon. Member for Kingston upon Hull, North mentioned the importance of early intervention, for young people in particular, which is lacking in too many places.
	Thirty per cent. of all GP consultations have a significant mental health component. Mental illness has enormous implications for social exclusion, is one of the biggest factors in the high level of disability benefit claims, and hits black and ethnic minority communities disproportionately, as many hon. Members mentioned. The Wanless report highlighted the fact that
	"For too long mental health has been stigmatised and starved of resources and national attention."
	I agree. The Healthcare Commission inspections last year found that standards in NHS mental hospitals were markedly poorer. Despite the apparent priority that the Government said they gave to mental health and the publication of the national service framework in 2000, we have not had a debate in all that time.
	The World Health Organisation predicts that by 2020 depression will be the leading cause of disability and the second biggest contributor to illness in the developed world, after heart disease. Surely mental illness, particularly among young people, is one of the most worrying public health time bombs ticking away, with enormous implications for the health of future generations, employment and financial cost to the NHS.

Anthony Steen: Will the shadow Minister give way?

Tim Loughton: Will my hon. Friend forgive me? We have very little time.
	Despite all the evidence, mental health merited just a passing reference amounting to two and a half pages in the 2004 White Paper on health and is virtually absent from last week's White Paper. The Government promised to update mental health legislation and bring the 1983 Act in line with new practices and treatments in the 21st century, but that Bill remains in doubt, despite the publication of the original draft Bill in June 2002 and a second draft in September 2004, and the scathing report of the pre-legislative scrutiny Committee last year. There are real doubts whether we will see the Bill this Session, as the Government promised.
	Conservatives believe that mental health needs to be treated more seriously and more urgently than that. That is why we are holding this debate in our time today, and why we have held three mental health summits at Westminster in recent years and plan more. That is why we produced a separate, detailed mental health manifesto at the last election, contrary to the impression given by the hon. Member for Hackney, South and Shoreditch (Meg Hillier). That is why we set up an expert panel in 2004 to produce an alternative mental health Bill, and stand ready to introduce it as a private Member's Bill if the Government continue to fail to honour their promise to introduce a Bill of their own or refuse to adapt their Bill significantly in the light of the near-universal condemnation that it has received. We need to examine the issue of mental health holistically. Of all the areas in health care, mental health provision needs a joined-up approach, which has too often been missing.
	Many hon. Members mentioned funding. Investment in mental health has risen, but not to the level needed to implement the NSF. It has not kept pace with rises in the NHS budget generally. There are serious worries that mental health trusts will bear the brunt of the current deficit crisis, just as the new mental health trusts inherited many of the worst overdrafts after the last restructuring of services—a point mentioned by the right hon. Member for Oxford, East (Mr. Smith). The near-zero figure suggested by the Minister turned into 10 per cent. in his county, Oxfordshire. That was reinforced by my hon. Friend the Member for Banbury (Tony Baldry) and the hon. Member for Cambridge (David Howarth). There have been significant cuts, leading to the diminution of services, and the cuts are not of the order of the very small snapshot amount contrived by the Minister. That is the reality of the services that our constituents are trying to access with increasing difficulty across the country.
	Expenditure on day services for mental health patients has fallen from £176 million in 2001–02 to £149 million in 2003–04, despite more people in the community needing those services. We have had many other examples from across the country. It is a false economy not to continue the investment in such services. That is why Conservatives want a fairer share of the health funding cake to be spent on mental health services. That might start to address the problem of stigma mentioned by so many hon. Members.
	On choice and access, the Secretary of State has spoken much about the choice agenda in health, yet what choice is there, realistically, for mental health patients? The Government are bringing in the "choose and book" system, giving patients with physical health needs the opportunity to choose their hospital and treatment times, yet mental health is one of the few areas where that will not be introduced across the country. Too often, the only treatment available to patients is the GP's prescription, as my hon. Friend the Member for Tiverton and Honiton (Angela Browning) described so well.
	Can it be right that 40,000 children—some as young as six—and adolescents are prescribed anti-depressants each year? Those drugs are effective, and in many cases they may be appropriate, but are they not prescribed because alternative therapies are not available and doctors do not have time to tease out the more complicated symptoms that accompany mental health   problems? It is not like presenting with a broken   leg. More time is needed.As the Sainsbury centre and our own surveys report, many GPs complain that they have had no access to cognitive behavioural therapy. Elsewhere, patients can wait six months for basic counselling, and all the while their conditions deteriorate, yet we know that early intervention is key.
	In his hard-hitting report last year on the economics of mental health, Lord Layard proposed a dramatic overhaul of our priorities, the setting up of a network of 250 therapy centres and a new cohort of 5,000 cognitive behavioural therapy specialists. We need radical thinking backed up by long-term investment if we are to diffuse the ticking time bomb.
	We need also not to treat people with mental illness in silos. Mental health patients suffer physical conditions like the rest of us, such as heart disease, obesity and diabetes. Worse, they have pronounced medical conditions. A schizophrenic is likely to have a life expectancy 10 years shorter than the average one of us. They are twice as likely to die from respiratory infections. Like everyone else, they suffer those diseases, but they frequently complain that they are labelled primarily as mental health patients when they visit their GP and are treated differently.
	Spending on mental health promotion is crucial, but it is a scandal that at £3 million it represents just 0.04 per cent. of the total expenditure on mental health services, at a time when many experts say we should educate the population better on mental health issues, not least through the curriculum in schools. It is a false economy not to do so, yet it does not feature in the "healthy schools" programme.
	We need to be bolder and more imaginative in the places where people can access mental health services, often anonymously, not least for the 14 to 16-year-old boys, who experience some of the highest levels of stress and depression but see their GPs least frequently of all. Similarly, we need to do much more to encourage more people from black and ethnic minority communities to present with mental problems earlier. We have heard all the figures showing that they are much more susceptible to mental illness.
	It is a scandal that 90 per cent. of prisoners have some kind of mental health or substance abuse problems, yet some of the worst mental health services available. Too little imagination and flexibility are available to divert people with severe mental health problems away from prison entirely. It is no coincidence that the prison population has increased tangentially to the decrease in acute mental health beds in the NHS. Perhaps if we start to address those problems, we can start to remove the stigma that still attaches to mental health issues.
	Finally, on the mental health work force, we hear all the time about doctors and nurses, hospital waiting lists and numbers of operations. We hear little about the one in six consultant psychiatrists' posts currently unfilled or the 5 per cent. vacancy rates for mental health nurses in hospitals.
	We need to do more to commit to a serious recruitment campaign among mental health professionals and to bring back the morale of a demoralised profession. We need to do more to encourage employers to look dispassionately at taking on the 80 per cent. of potential workers with a mental illness on disability benefits who want to work, only 20 per cent. of whom get the opportunity to do so. The Supporting People programme is being cut at a time when it is doing good work, as we saw this morning in Brent in a project supported by that budget.
	If we can do something urgently and seriously to tackle these problems, perhaps at long last we can go some way to turning the tide against the stigma that still pervades the whole subject of mental illness. That is in sharp contrast to the way in which it is handled in many other European countries, and it succeeds only in fuelling the ignorance and prejudices displayed too often by some elements in the tabloid press.
	We cannot hope to tackle the stigma of mental illness when we still have a wholly unacceptable draft Mental Health Bill hanging over the heads of everyone with a mental illness or anyone who needs to be encouraged to present themselves for such a diagnosis. It is a Bill that is more about locking people up than giving them the support and treatment that they need for what is first and foremost an illness. It contains fundamental flaws and, according to the British Medical Association, would quickly bring mental health services to a standstill. The Bill, in its current form, could prove to be counterproductive and yet another example of the attacks on civil liberties that are becoming the hallmark of this Government. It can only harm the prospects of reducing the stigma attached to mental illness. I urge the Government to clarify their intentions now and to listen to the mental health community, who are up in arms.
	Above all, the Government need to live up to their bold words about making tackling the inequalities in mental health a Government priority. To continue to fail to do so is a false economy and a serious threat to one of the most serious public health challenges facing our nation today.

Caroline Flint: This has been an interesting and thoughtful debate. It shows that a wide-ranging discussion needs to be had not only by those in health but by those in education, local authorities, the voluntary sector, employers—whether in the public or private sector—and agencies such as jobcentres in order to tackle the variety of needs that people with mental health problems face in trying to live their lives. That is important given that much of the debate raised questions about the way in which people often work in silos in relation to mental health. We are trying—there is apparently consensus across the House on this—to challenge the importance that every organisation gives to how it meets the needs of those with mental health problems in their community, no matter what that organisation's core remit.
	The debate has given the Government the opportunity to demonstrate our commitment to improving the lives of the one in four people who suffer from mental illness at some point in their lives. There has clearly been increased investment in, and modernisation of, mental health services since the publication of the national service framework in 1999.
	Members made several accusations. To deal with one, I understand that the Tory-Liberal Democrat council in Birmingham recently cut £2 million from the Supporting People programme and moved it to another area.

David Howarth: rose—

Caroline Flint: I am afraid that I am not going to give way because I do not have a great deal of time and the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), took many interventions earlier.
	In the seven years since the national service framework was introduced, ambitions have been surpassed in many areas, but I am the first to admit that a great deal more remains to be done. There is consensus across the House in congratulating and thanking all those who have worked so hard to make these reforms happen. I hope that we are moving towards a system of community care, supporting people in their own homes and working to increase inclusion and decrease stigma. It is equally important that a full range of high-quality in-patient services are there for those who need them. We have recently concentrated particularly on getting the balance right in that respect.
	One of the ambitions of the White Paper that we launched last week is to engage with the issue of services that could be provided outside hospital. As the Minister responsible for public health, I fully take on board matters to do with prevention and public health for those with mental health problems, as I would with anybody in the community. That is at the heart of our desire to bear down on the health inequalities that still exist. We have made considerable strides towards high-quality mental health services, but we have an even more ambitious direction of travel. We are committed to supporting good mental health throughout the population and improving preventive mental health services in the community.
	I turn to the points raised in the debate. I agree with the hon. Member for Northavon (Steve Webb) that it is important to integrate health and social care budgets. The White Paper sets that out very clearly. We can do plenty more work in that area, which creates opportunities for innovation and imagination.
	The hon. Members for Northavon and for Banbury (Tony Baldry) talked about GPs. Practice-based commissioning will help GPs to manage more effective care pathways and allow primary care trusts to commission new services on behalf of GPs. Coupled with an enhanced role for GPs in managing mild to moderate depression in better monitoring mental health, we hope that this will create more flexibility and   incentives for GPs and PCTs to manage mental health.
	The hon. Members for Northavon and for Tiverton and Honiton (Angela Browning) mentioned the new Bill. They are right to say that it will require a careful balance between a person's right to make decisions about themselves and society's duty to protect people with serious mental disorders from harming themselves, or occasionally others. We are confident that our Bill will achieve the right balance, but I am sure that my hon. Friend the Minister listened carefully to the points made in the debate.
	Members asked about prisons as places of safety when there is a crisis situation. Last year, we announced £130 million to help trusts to create proper places of safety for those who need a settlement under the Mental Health Act 1983 instead of relying on police cells or accident and emergency departments. There has been considerable work within A and E departments to improve the relationship with social services on quick referrals. On prison health, 360 mental health in-reach staff are in post, exceeding the commitment to 300 in the NHS plan. NHS mental health in-reach teams now provide services in 102 prisons. Again, there is progress but more to be done.
	My right hon. Friend the Member for Oxford, East (Mr. Smith) and the hon. Members for Banbury and for Cambridge (David Howarth) mentioned particular issues in Oxford and Cambridgeshire. I congratulate my right hon. Friend on the three-star trust rating; I am glad to hear about that progress. Last week, the Department issued a set of financial rules for the next financial year, requiring local health economies to develop an operating surplus to create a buffer against unplanned financial problems. We will work hard with NHS bodies to ensure that good finances are in place over the next few years. If we act now, we will help to protect mental health services better against the pressures that some have faced this year. That is an important challenge that we must face up to.
	The hon. Members for Cambridge and for Banbury asked about payment-by-results work for mental health. We agree that that is an important issue, and we are working hard to tackle it. We have set out our intention to pilot a new currency in 2007–08, and the move to develop a tariff is being taken forward by the mental health team. We take the matter seriously, but we are not launching an untried system on mental health services.
	The right hon. Member for Charnwood (Mr. Dorrell) made an interesting speech in which he talked about the integrated delivery of care. That is indeed vital to good services for patients. However, he failed to talk about how in 18 years he missed the opportunity to put some of his ideas into practice.
	My hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) made a good speech in which she acknowledged the investment and the changes in attitudes and culture when providing services. However, she was also challenging. We have asked Professor Louis Appleby to co-ordinate children, adult and elderly people's services. I believe that to be important. We have a national service framework for young people's mental health, which outlines standards for services and, indeed, sets world-class standards for their provision. Of course, we must ensure that they are delivered on the ground and we want the help of colleagues from all parties to hold agencies to account for that.
	My hon. Friend also made good points about women. We have issued guidance on ensuring that in-patient services are safe for women—we take that seriously. My hon. Friend and the hon. Member for Northavon made points about mixed-sex wards. Ninety-nine per cent. of wards are not mixed sex—they have separate sleeping and bathroom facilities. However, we are working to improve matters. Sure Starts and refuges have an important role to play as first contacts for many women—and their children—who may suffer from mental health problems.
	I stress to the hon. Member for Tiverton and Honiton that we are spending £60 million on pilots to protect older people's health and we are piloting new centres for older people's services, which will include work on tackling loneliness. She made a valid and interesting point.
	My hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) was right to say that we must tackle the problems of stigma that prevent people from getting work. I hope that we can consider better methods of challenging those problems through the pathways to work programme. She also made points about ethnic differences. The issues are complicated but we have done some work on examining the reasons for problems that mean that some people from black and minority ethnic backgrounds are deterred from coming forward until their illnesses are more severe. I congratulate her area on tackling those problems, and my hon. Friend the Minister of State has promised to visit.
	The hon. Member for Rugby and Kenilworth (Jeremy Wright) spoke about post-traumatic stress disorder. We acknowledge the importance of that work. We have evidence of what works from the National Institute for Health and Clinical Excellence and we have issued advice to all GPs in the NHS. That was invaluable in providing support for victims of recent tragedies such as the bombing on 7 July, when different agencies, including the voluntary sector, came together to help with the obvious need for counselling and support.
	I shall not specifically answer the points of the hon. Member for East Worthing and Shoreham (Tim Loughton) because, if he reads my hon. Friend the Minister's opening speech, he will realise that she covered them. However, I stress that mental health has never been higher up any Government's agenda. The result has been record increases in investment and staffing. Thanks to the efforts of the staff, front-line services have become more responsive.
	We remain some way from fulfilling all our ambitions but, based on what we have said today, I urge hon. Members to vote against the motion.

Question put, That the original words stand part of the Question:—
	The House divided: Ayes 215, Noes 283.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House recognises that the Government has made mental health a key priority through the National Service Framework for Mental Health and the NHS plan; welcomes the achievements set out in the National Director's progress report published in December 2004; further welcomes the record increases in investment and staffing; notes that under this Government there are now over 700 specialised community mental health teams and that suicide rates are the lowest since records began, that there are 1,200 more consultant psychiatrists, over 3,000 more clinical psychologists, and 8,000 more mental health nurses than in 1997; further welcomes the Government's five year action plan to tackle inequalities in mental health services amongst black and ethnic minority communities and its action to tackle social exclusion in mental health; acknowledges the Government's commitment to early intervention to support good mental health and improve preventative mental health services in the community, as set out in the recent White Paper "Our health, our care, our say: a new direction for community services", including by improving public understanding of mental health issues to counteract stigma and discrimination, expanding access to psychological therapies including cognitive behavioural therapy, promoting the use of information technology recently reviewed by the National Institute for Health and Clinical Excellence which supports people to take charge of their own treatment, and working with health professionals to improve standards in mental health services in the community; and further welcomes the Government's commitment to reform mental health legislation as soon as parliamentary time permits.

NHS Reorganisation

Madam Deputy Speaker: We now come to the second Opposition motion debate, on the reorganisation of primary care trusts, strategic health authorities and ambulance trusts. Mr. Speaker has selected the amendment in the name of the Prime Minister.

Stephen O'Brien: I beg to move,
	That this House believes the structures of the NHS should serve the needs of the service and patients; notes the Health Select Committee's report on Changes to Primary Care Trusts (HC 646); regrets the mishandling of the reorganisation of primary care trusts (PCTs) by the Department of Health; wishes to see administration costs minimised; further believes that structure must follow function and that the future functions of PCTs have not been clarified; further believes that strategic health authorities should be abolished; further believes that ambulance trusts should not be required to undergo restructuring unless the services themselves request it; fears that restructuring proposals will seek to mask the consequences of £1 billion worth of deficits across the NHS; further regrets the loss of morale amongst NHS staff in PCTs; and calls on the Government to enter into a new and genuine debate about NHS structures, so that the service can better meet its aim of comprehensive quality healthcare available to all, based on need not ability to pay.
	As we start this debate, let us agree about the common ground between us. Nothing that I shall say this evening undermines or undervalues the constant, dedicated and professional work done by NHS staff. Doctors, nurses—indeed, my wife is a nurse—the service's many other clinical and technical staff, porters, volunteers, cleaners, even managers and administrators all are highly skilled and good at their jobs.
	I pay tribute to them and their work. The Opposition's job is to press the Government to optimise their support for what NHS staff do in delivering taxpayer-funded health care that is free to all who need it at the point of use. I say that with deep conviction, as one of my children recently had to undergo a serious operation at Alder Hey hospital in Liverpool. Neither he, my wife, nor I can praise highly enough all those NHS staff who were involved in his excellent treatment.
	Like the country at large, the Opposition regard the NHS as a top priority. We are optimistic about its future and determined to see it improve. It therefore comes as a surprise to most people that a great many NHS trusts face serious and worsening deficits totalling something of the order of £1 billion gross, with wards being closed and services curtailed.
	We have just finished a debate on the vital matter of mental health and, even there, cuts are being made in availability, provision and access. We are now debating the Government's latest proposed reorganisation of primary care trusts, strategic health authorities and ambulance trusts. One fears that it is a case of the Government fiddling while Rome at least smoulders. As soon as the Government hit the inevitable choppy waters—in this case, ballooning deficits in a quarter of all trusts—that were the inevitable consequence of their own policies and targets as well as their most recently introduced organisational and structural tinkering and meddling, they reach for their reorganisation manual yet again.

John Redwood: My hon. Friend is making a strong case. Is there not a danger that the amalgamation of these trusts could impose a lot of extra administrative costs as a result of new logos, new staff—owing to the need to employ regional and local people—and new properties? That is the last thing that we want to spend money on at a time when we need more to spend on nurses and doctors, certainly in my area.

Stephen O'Brien: My right hon. Friend is correct. There is always a transfer cost associated with any such move, but it is nonsense to incur such costs when there is no identifiable benefit, given that it will involve hard-pressed taxpayers' money that is needed for front-line services.

Jim Devine: When the Conservatives were in power, we had 47 trusts in the Scottish health service. Under the Scottish reorganisation, that figure has been reduced to 15. We also reduced the number of senior managers by 27 per cent. and those savings have gone into paying for front-line staff. Does the hon. Gentleman not welcome that?

Stephen O'Brien: I am sure that the Scottish Executive would very much like to debate that matter, but this House has no jurisdiction over it. I hope that the hon. Gentleman will reflect on that point, having taken up time in this debate with a matter over which we have no authority whatever.

John Gummer: Although we have no control over the Scottish Executive, the hon. Member for Livingston (Mr. Devine) will be voting on English trusts in this debate.

Stephen O'Brien: My right hon. Friend is right. Roll on the time when we are in Government and can introduce English votes for English laws.
	There have already been six reorganisations since Labour came into office. The merger of strategic health authorities and primary care trusts will represent the seventh, and the forthcoming merger of NHS ambulance trusts will be the eighth.

Gwyneth Dunwoody: Will the hon. Gentleman give way?

Stephen O'Brien: Of course I will give way to my neighbour.

Gwyneth Dunwoody: I am grateful to the hon. Gentleman. Am I to take it from his remarks that he does not believe in an integrated national health service covering the whole of the United Kingdom?

Stephen O'Brien: I hope to mention the hon. Lady in dispatches later in my speech. I am intrigued by her question, because I hope that she knows—not least because of my own personal connection with her—that we have a strong commitment to the NHS as a national health service. By "national", we mean the United Kingdom. However, we must recognise that the authority and accountability for NHS services in Scotland has now been devolved and it would therefore be inappropriate for me to take up the House's time dealing with matters of Scottish accountability.
	The Government have an addictive personality disorder and we are constantly told that all such habits are costly and have dire consequences. We have been here before. As recently as 2001, the Government announced that 302 primary care trusts were to be established as statutory bodies to replace the health authorities and that nine regional offices of the NHS executive were to be abolished in favour of 28 strategic health authorities. The Government's proposals for PCTs and SHAs effectively return the NHS to the same map that they abolished only three years ago. The Health Committee slated this U-turn, stating:
	"A return to structures which are similar in size and function to previous Health Authorities raises important questions about why the shortcoming now being identified"—
	by the Government—
	"could not have been easily anticipated and addressed before the PCTs' introduction three years ago".
	Most worryingly, the cost of this reorganisation will reach £320 million, which I think gives a quantified answer to the question that my right hon. Friend the Member for Wokingham (Mr. Redwood) asked earlier. Given the increased resources that have rightly been made available for the NHS, it is little wonder that there is a constant refrain from constituents and clinical staff alike of, "Where has all the money gone?"

Rob Marris: I understand the hon. Gentleman's point about reorganisation in the NHS, but will he explain why the motion that he is supporting calls for another one, namely
	"that strategic health authorities should be abolished".?
	Is that not another example of the kind of reorganisation that he is decrying?

Stephen O'Brien: I have some respect for the hon. Gentleman's normal analysis, but he must recognise not only that we would replace strategic health authorities if we had the chance, but that they will naturally become extinct in three years anyway, if the Government have the courage to implement that move. We are simply trying to save some money by advancing that change rather faster.
	On 28 July 2005, the Department of Health proposed a reduction in the number of PCTs from the present level of 303 to between 100 and 150, to be aligned with county council boundaries where possible, and a similar reduction in the number of SHAs. Changes to PCTs were expected to be completed by October 2006, and changes to SHAs by July 2006. On 1 December 2005, the Department of Health published the plans that had been submitted to it for consultation, including plans to reduce the number of PCTs to a minimum of 115, and to reduce the number of strategic health authorities to between nine and 11, along the lines of the Government offices for the regions. Consultation on that reorganisation is ongoing, so there is no question but that this restructuring plan is of the Government's making. They cannot slither behind the trusts to avoid their direct ministerial accountability.

Philip Hollobone: Is my hon. Friend aware that the chief executive of the Northamptonshire Heartlands primary care trust, Peter Forrester, has to spend half his time in some weeks battling to save that popular primary care trust, which is taking him away from giving his time to front-line issues?

Stephen O'Brien: I gather that wards are also being closed in Northamptonshire. That situation is replicated right across the country. I was talking to a local physiotherapist the other day and she told me that her job description required her to administer for 25 per cent. of the time and give physiotherapy for 75 per cent. She then told me that the situation was now reversed and that she was now lumbered with all the administration, because the Government are stealthily removing administrative support in an effort to avoid the charge that they are diminishing front-line services.
	How can there be any sense in the Government proposing changes to the structure of primary care trusts unless they have first established with clarity what the functions of the PCTs are to be? The Government's document, "Commissioning a patient-led NHS", called for PCTs to become
	"patient-led and commissioning-led organisations with their role in provision reduced to a minimum"
	by 2008. In the face of fierce opposition from NHS staff employed by PCTs, from MPs, and from the Royal College of Nursing—which launched, but has now withdrawn, an application for judicial review of the decision—the Government have since retreated from their strident position. The Secretary of State said on 11 November 2005:
	"I know that many of you were very unhappy about what we said at the end of July . . . I am very sorry that many staff have been caused such anxiety . . . Any move away from the direct provision of services will be a decision for the local NHS within the framework set out in the forthcoming White Paper and after local consultation."
	There we have it: the Government's U-turn. So far, so normal for this Government, but, even though common sense would dictate that they should, they did not even review the design of the new PCTs to ensure they were fit for their new purpose as commissioners as well as local providers. Those roles encompass massively different skills and levels of authority, governance and accountability, as anyone with even a smattering of management experience could see.
	On 11 January 2006, the Health Committee attacked the Government's indecision, saying
	"we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions".
	The Department of Health's NHS operating framework for 2006–07, published on 26 January 2006, offers little further clarity. It states:
	"From 2007 each PCT will be expected to review formally and systematically whether local services are delivering high quality, effective and efficient care . . . There is no requirement for PCTs to divest themselves of provision, and nor will there be in the future . . . Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions."
	On that last point, incidentally, I have to say that I am already receiving letters—I expect that my hon. Friends on the shadow health team are, too—alleging a growing web of conflicts of interest and worse. That is no laughing matter for a Government-designed system, as it makes the Government complicit, and they will be guilty of intended consequences, on which we will be required to hold them to account.
	The Health Committee also noted that NHS organisations were given less than a month, during the summer holiday period when many key figures were absent, to put together proposals for changes to local services. The chair of North West London SHA described the consultation process as "flawed". The Health Committee concluded:
	"if the Government truly believes in a patient-led NHS, it should have started its reforms with a patient-led consultation process, rather than the top-down process we are clearly seeing".

Eric Martlew: I remember that the Conservatives fought the election saying that they would introduce £35 billion of cuts, £600 million of which would come from NHS bureaucracy. Where is the hon. Gentleman going to make those cuts? What would he do?

Stephen O'Brien: Apart from the fact that the Government are clearly attempting to fulfil their own manifesto promise of £250 million of cuts, the hon. Gentleman should not read so much into the note distributed to him and his fellow Back Benchers by the Labour health team, and signed by the special advisers to the Secretary of State, that tries to suggest that that is our position, not recognising that it is nothing to do with the policy that we promote.
	Quick consultations always suggest a foregone conclusion. I have been contacted by GPs in my constituency who work within the Central Cheshire PCT and who are worried that that is the case. They understand that the Government's current preferred option is that all four existing Cheshire PCTs became one, but fear that that will be too large, impacting on local links, covering different care pathways and looking to both Manchester and Liverpool, which is inappropriate for my constituents. With them, I favour Central Cheshire and Eastern Cheshire PCTs combining. They are also concerned, as are all Opposition Members, that those structural changes are a deliberate ploy by the Government to mask the consequences of deficits and their impact on patients.

Mark Harper: My hon. Friend is right. Today, the Gloucestershire health community issued a press release and the chief executive of the acute hospital trust said that the current difficulty with deficits will be magnified by the significant reduction in prices paid with the changes in the national tariff. The trust in Gloucestershire faces a cut of £21 million—a 7 per cent. reduction in its spending next year—if it treats the same number and mix of patients and will face tremendous challenges that will lead to job losses. Those are the problems faced in Gloucestershire.

Stephen O'Brien: I am grateful to my hon. Friend, who is working hard for his constituents. He recognises that there is nothing worse than a Government who provide perverse incentives for all the wrong directions and decisions to be taken in an effort to try to meet their targets.

Graham Stuart: Will my hon. Friend give way?

Stephen O'Brien: I am conscious of the need to get to the end of my remarks to allow more Members to speak. If my hon. Friend will forgive me, I will not take too many interventions.
	The Cheshire GPs fear that there will be a levelling down of services and cuts to front-line patient services if there is a merger with the debt-ridden Cheshire West and Ellesmere Port and Neston PCTs. As has been outlined, good PCTs such as Central Cheshire are now to be penalised to prop up disastrously underperforming ones such as Cheshire West, which has KPMG in. The Government are 100 per cent. responsible for that muddle, as well as for the deficits resulting from rising cost pressures and the cost of meeting Government targets.
	Why are the Government charging ahead with all that? It is neither for NHS patients nor those who work in the NHS, but that is what the Minister will no doubt claim when she responds. One only needs to witness the collapse in morale among NHS clinical and non-clinical staff to know that the Government are in serious denial. Can anyone doubt that the Government are conducting a sham consultation on all these changes? Can it be in doubt that the Government will not break the habits of a lifetime, have no intention of respecting the consultation processes and certainly not the responses, and will press on with their proposals regardless of the responses received? We need look no further than yesterday's announcement on the police for proof of that.
	The proposed merger of strategic health authorities into remote bodies aligned with Government offices for the regions is, despite all the Government's ever more wild and shrill protestations, yet another manifestation of their addictive personality—their obsession with regionalisation, even though SHAs have patently failed in their key task of performance managing NHS organisations. One does not get a £1 billion deficit if one has been a success.

David Howarth: Unlike the hon. Member for Wolverhampton, South-West (Rob Marris), I welcome the motion's proposal to abolish SHAs. Does the hon. Gentleman agree that they do not seem to have any function, that their strategic functions should be carried out by the Department of Health and that their planning and capacity functions should be carried out by PCTs? There is no point in having them at all.

Stephen O'Brien: I am glad to hear that the hon. Gentleman has come to our view. He is correct that SHAs have lost all their purpose and are therefore no longer a worthwhile or value-for-money option for the taxpayer.
	Indeed, SHAs have come under attack from Government Back Benchers. During Health questions last week, the hon. Member for Warrington, North (Helen Jones), who is not in her place, said about the Cheshire and Merseyside SHA,
	"I, my constituents and many Labour Members have no confidence any more in what is an increasingly Stalinist and out of touch health authority",
	to which the hon. Member for Crewe and Nantwich (Mrs. Dunwoody)—who, I am glad to see, is in her place—added,
	"It is not nearly that competent."—[Official Report, 31 January 2006; Vol. 442, c. 159–60.]
	The way in which SHAs have undertaken their responsibility for performance management is a disaster. The Secretary of State has sent in turnaround teams to PCTs—proof, if ever there was, of the failure of SHAs to oversee those trusts, and an immense additional and avoidable burden on the taxpayer. I would not mind the Government paying McKinsey were there no Merseyside and Cheshire SHA, but the imposition of KPMG on 18 trusts up and down the country at vast expense shows that the SHAs have not been doing their job. The taxpayer is paying twice over, and over the odds the second time: once for the SHA employees who are supposed to keep trust finances in order and once for the consultant to sort it all out. Surely the Department should ensure that it employs people who can do the job and sacks those who cannot. The turnaround programme is proof that SHAs are not up to it, that this three-year-old Government design has failed and that SHAs should therefore be scrapped. In any other walk of life, and under any other Government, it would be plain that SHAs have failed, and that some, such as Surrey and Sussex, have presided over an almost complete collapse in their health economy. We can, and should, dispense with SHAs. We just wonder whether the Government have the courage to take that obvious step.
	We now come to the ambulance trusts. In June 2005, the Government's review of ambulance services, "Taking Healthcare to the Patient", was published. It recommended a reduction in the number of NHS ambulance trusts from 31 to 28. However, on 14 December 2005, the Department of Health began consultation to reduce the number of NHS ambulance trusts to 11, aligned with Government office for the region boundaries. That consultation will close on 22 March. The Health Service Journal reported on 22 September 2005 that the Department of Health expects the changes to be in place by July—a bit swift for a genuine consultation.
	No one in the ambulance service called for this change.

Tim Boswell: Will my hon. Friend consider the Two Shires ambulance trust, shared between Northamptonshire and Buckinghamshire? It is a three-star trust, which will not only be torn apart but reconstituted, with our trust as part of a much wider regional trust and the other going to the south-east? Something that is perfectly effective that has its headquarters in my constituency is being destroyed and its seat of decision making is being removed to a place about 100 miles away.

Stephen O'Brien: I am grateful for the example that my hon. Friend outlines. He will derive great comfort from the fact that he is not alone, but no optimism, from the case to which I am about to refer.

William Cash: Will my hon. Friend give way?

Stephen O'Brien: I am about to mention Staffordshire, so my hon. Friend might want to hold on.
	The ambulance tsar, Peter Bradley, made a clear case for restructuring Avon, Gloucestershire and Wiltshire ambulance trusts, and for a revision of the Thames Valley trust. The Government took that as an excuse—it was not in the report, and at best they might claim, as a cloak, that it was implied—to reduce the number of ambulance trusts down to nine, 10 or 11. To implement that, the NHS Appointments Commission sent out letters on 30 January this year, to all MPs, I believe, asking for nominations for chairmen and chairwomen of the new NHS ambulance trusts. Do the Government think that we do not believe that the consultation is a foregone conclusion? Were the consultation genuine, money would not and should not be being spent now on the recruitment process; it is a highly questionable use of taxpayer's money.

William Cash: My hon. Friend may know that Staffordshire ambulance trust is regarded as one of the best in the country. Indeed, later tonight I shall present a petition with many thousands of signatures, because the people of our area are incensed at the fact that the trust is to be merged into a west midlands service. Does he accept that we are deeply concerned?

Stephen O'Brien: I fully accept that my hon. Friend and his constituents are, rightly, deeply concerned. I shall deal with Staffordshire shortly and I hope that he will be able to combine what I say with the representations that he is already making.
	The proposed regionalisation is simply not service-led. In fact, it is diametrically opposed to what the service needs. It is not enough that the people of the north-east rejected the Government's regionalisation agenda out of hand, which led to the withdrawal of similar proposals in the north-west and Yorkshire and Humberside. In a forlorn attempt to save the Deputy Prime Minister's face—I shall not inquire what type of face it is—the Government will ram the proposal through anyway, as part of their dogmatic regionalisation agenda.
	For ambulance services, local knowledge is key, as are small, efficient management structures. Where trusts have been merged, their quality has been destroyed. The trust that used to serve my constituency, the Cheshire ambulance trust, had three stars. It was merged with the Merseyside ambulance trust. The ensuing crisis has been so appalling that the chief executive of the joint Cheshire and Merseyside ambulance trust conveniently "resigned". The greater tragedy is that the trust has descended to a nil star rating.
	Only this weekend, I had cause to test the service. A horse rider fell on the road just outside my house, severely injuring her head. It was a serious injury. Luckily, my wife was on hand to give professional nursing help, as it took over half an hour for the ambulance to arrive. It had to be guided in by the nearest people who could be contacted by mobile phone, as the Warrington call centre never understood where we were.
	Concerns have also been expressed about the merger of  Staffordshire, West Midlands, Coventry and Warwickshire, Herefordshire and Worcestershire, and Shropshire ambulance trusts. There have been proposals to reduce control room numbers by co-aligning them with the police and fire services. The fire service in Warwickshire responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000 emergency calls. Both Staffordshire and Coventry and Warwickshire ambulance trusts are three-star rated. Where is the benefit in amalgamating them, especially if they suffer the same fate as Cheshire? It is not patient-led, it is no closer to the patient and it does not centre the service on local knowledge. The only changes that should ever happen are those requested by the ambulance service itself.
	My hon. Friend the Member for Lichfield (Michael Fabricant) has highlighted fears over the merging of Staffordshire ambulance trust, joining other Members from his area to meet the Secretary of State. He has pointed out that Staffordshire ambulance trust has the fastest 999 response time in Europe. He has met constituents living in Lichfield and Burntwood who would probably be dead today, because of slower ambulance response times, had Staffordshire been subsumed into the West Midlands trust.

Michael Fabricant: That is right.

Stephen O'Brien: I note what my hon. Friend says. When he met the Secretary of State for Health, she assured him and the Members who accompanied him that no decision had yet been made, but she did explain that there was a move towards regional emergency services. Where have we heard that before? In connection with police and fire services? Is it possible that the Conservatives may be right in saying that the Government's addiction to regionalisation is driving all the proposals?

Charlotte Atkins: rose—

Michael Foster: rose—

Stephen O'Brien: I will not give way, because I am about to end my speech.
	In their addiction to meddling, the Government turn to reorganisation whenever they face a crisis or their latest headline grabbing wheeze turns out—predictably—to disappoint. For all that, we see PCTs being forced to merge when there is as yet no clarity about their purpose. We see the Government clinging to SHAs while, at huge cost to the taxpayer, bringing in consultants to do the job that the SHAs were hired to do when the obvious answer to anyone but an over-proud Government would be to scrap the SHAs. We see ambulance trusts being forced into a dogmatic regionalisation agenda, having to bend to the Government's will although no one in the service advocates it and although there is no prospect of a better, speedier service for patients.
	We want better NHS services for our constituents. They do not deserve to suffer the cuts that are being forced on PCTs and other trusts to get the Government off the hook of the failure of their policies and their financial mismanagement of the PCTs, SHAs and ambulance trusts that they themselves set up only three years ago. Of course we also want administration costs to be minimised. The way in which to do that is to reduce the amount of administration and bureaucracy, rather than bringing about yet another reorganisation. Our constituents and NHS patients will not fall for the latest Government ploy to mask their own policy failures.

Jane Kennedy: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the Government's determination to reform primary care trusts (PCTs) and strategic health authorities (SHAs) to ensure all patients get the services they need, to shift the focus of services more towards prevention and tackling health inequalities, to engage better with GPs in developing services that meet patients' needs, to reduce bureaucracy and to deliver better value for money for taxpayers; further welcomes the widespread support within PCTs and SHAs for the principles on which Commissioning a Patient-Led NHS has been based; and further welcomes the Government's consultation on reforming ambulance trusts to ensure more care is provided in the home and at the scene, to give better advice to patients over the telephone and to deliver faster response times to save more lives, in line with the recommendations from the National Ambulance Adviser Peter Bradley's review 'Taking Healthcare to the Patient: Transforming Ambulance Services.'."
	I think that this is the first occasion on which I have crossed swords with the hon. Member for Eddisbury (Mr. O'Brien). I well remember the by-election in July 1999, when the hon. Gentleman only just held off a challenge from Labour. That near-success was almost entirely due to the excellent campaign, whose slogan was "Vote Labour or the fox gets it". None the less, it is a pleasure to see the hon. Gentleman at the Dispatch Box. He has consolidated his position in Eddisbury, on which I congratulate him. I wish him a long career as an Opposition spokesman.
	The NHS is being restored to good health. It has more doctors, more nurses and better facilities. The revolution in quantity of care must, however, be matched by a revolution in quality of care, with equal access for all and no charges for operations. That means new types of health provision, more say for patients in how, where and when they are treated, and tackling ill health at source.

Graham Stuart: Will the Minister give way?

Jane Kennedy: I should like a moment to get into my speech, I will give way later, but I am very conscious of the 10-minute limit on Back-Bench speeches and—like the hon. Member for Eddisbury—I want to keep my remarks to a minimum if I can.
	The phrases that I just used are the promises that we made in our manifesto. That is what these structural changes are set to achieve. I hoped that the hon. Member for Eddisbury would pay a bit more attention to the manifesto on which he stood at the last election. That manifesto pledged to implement the James report, which had a clear attitude to what should happen to PCTs. Only nine months ago, the Conservatives said that they would radically reduce the intrusive bureaucracy that the PCTs had become, removing 30,000 administrative staff and saving £636.6 million a year. We did not hear whether that was still the hon. Gentleman's policy. The thrust of his argument consisted of an objection to the reorganisation that we are proposing.

Nicholas Soames: The Minister and I will agree that in the past five years the NHS budget has indeed increased substantially, while productivity has unfortunately failed to increase at the same rate. Does the hon. Lady agree that the NHS has one of the most committed work forces in the country, and that its biggest failure is the failure to engage properly with its professional staff—the doctors and nurses who are capable of delivering all the service changes that she proposes? Does she agree that much more needs to be done in that regard?

Jane Kennedy: It is a pleasure to see the hon. Gentleman restored to us in good health. When he is not here, the House is the poorer for it. His point is fair. When consultations are taking place, it is important for those who have strong views, particularly those who are most closely affected—patients and the staff who deliver services—to be listened to, and to be involved in the consultations.

John Redwood: Will the Minister give way?

Jane Kennedy: I want to finish my comments about the motion.
	In our manifesto, we said that by removing £250 million from the management costs of PCTs and SHAs we could redirect the resource to front-line NHS services. Within nine months, we are fulfilling our promise and the Conservatives are breaking the promises made in their manifesto. We have heard no word from them about what they would do about PCT administration. We may have turnaround teams assisting the NHS organisations that are struggling with deficits, but the Tories have a turnaround leader who changes their policy every five minutes.

John Redwood: Can the Minister tell us how much the Department has spent in the past year on management consultants? Does she agree that we are suffering from a surplus of management consultants and a shortage of medical consultants?

Jane Kennedy: A tiny proportion of the amount that we spend on administration in the NHS is spent on consultants. I do not have the exact figure to hand. I will look into the detail, but I am confident that we use consultants to very good effect. That is demonstrated by the way in which services are improving.

Jim Cunningham: rose—

David Taylor: rose—

Jane Kennedy: I am spoilt for choice. May I make one more point on the James review, and then I will give way?
	The James review recommended the abolition of strategic health authorities. In the motion we see that writ large, but we have heard nothing from the hon. Member for Eddisbury about who will oversee the expenditure of taxpayers' money in the regions, and who will maintain strategic oversight of service development across a wider geographic area. As my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) said, it is a question not of reorganisation per se, but of what kind of reorganisation we take forward.

David Taylor: The House would agree that there is probably no magic number in relation to the size of population that is appropriate for a primary care trust, but if 150 primary care trusts covering the 50 million population of Great Britain—just over 300,000 people per PCT—seems appropriate, why are we getting rid of a successful one, Charnwood and North West Leicestershire, which serves a population of about 250,000, which is about the right size, which is big enough to deliver services, and which is effective and small enough to be accountable to the three MPs that represent its area? Why is that being absorbed into a 650,000 mega-doughnut outside the city of Leicester?

Jane Kennedy: My hon. Friend makes a strong point about the concerns in his area. I will come on to those questions in a moment, if he will allow me.

Jim Cunningham: Surely the answer to the Tory criticisms is that we do not hear so much now about people on trolleys who cannot get beds in hospitals. Had there been the deficits under the Tories that they are attacking tonight, we would have had hospital closures. Instead, under this Government we have new hospitals.

Jane Kennedy: I am grateful to my hon. Friend for his comments. His analysis is right.

Several hon. Members: rose—

Jane Kennedy: I will make some progress, if I may.
	I know that the reconfiguration of strategic health authorities, primary care trusts and ambulance trusts has aroused a great deal of interest. The Health Committee recently published a report that provides a helpful contribution to the debate. We will respond in due course to that report, but I am glad of the opportunity today to explain the position and what the Government are doing to change the structure of those organisations for the benefit of patients and to improve value for money.

Several hon. Members: rose—

Jane Kennedy: May I make a little progress and then I will be happy to give way to the hon. Member for Bournemouth, West (Sir John Butterfill).
	Investment in the NHS is rising rapidly—it has risen from £33 billion in 1997–98 to more than £90 billion in 2007–08—but that increase will bring us to the European average of GDP spent on health services, which shows how far behind the UK fell under the tender care of the Conservative party.

John Butterfill: rose—

David Heath: rose—

Jane Kennedy: I give way to the hon. Member for Bournemouth, West.

John Butterfill: The Minister has been very generous in giving way. She may remember that Bournemouth used to be part of Wessex regional health authority, which was abolished by the last Conservative Government and was not long lamented, but it had one convincing aspect—it took in not only Bournemouth and Poole hospitals, but the Southampton teaching hospitals and Odstock hospital in Salisbury, Wiltshire, all of which co-operated to form one unit. The proposal that is before us now is for either a strategic health authority for the whole of the south-west region, or two authorities for the south-west region divided horizontally. Can she explain why we are not being permitted the possibility of crossing the regional boundary? Is it to do with regional policy, rather than efficient administration?

Jane Kennedy: It is not being driven by regional policy; it is entirely being driven by efficient administration of the NHS. However, there are issues of coterminosity, to which I will come later—not too much later, I hope—in my comments.

David Heath: rose—

Kenneth Clarke: rose—

Jane Kennedy: I give way to the right hon. and learned Member for Rushcliffe (Mr. Clarke).

Kenneth Clarke: May I first say that I agree with the Minister that there are too many of these administrative bodies, authorities and trusts and that some reorganisation is called for to achieve some efficiency and reduction in management costs? It would be easier to know where we were going and settle all the boundaries if the Government were consistent about what the reorganisation is actually for. The primary care trusts were set up when the Government abolished GP fundholding. They then suggested that fewer PCTs were required to supervise practice-based budgeting, which is the same thing that they are going back to. They then started to consult on the boundaries on the basis that there should be new commissioning authorities. Halfway through, they changed their mind. They now say that the new PCTs will be commissioning authorities and will directly employ a lot of staff. Consulting in that confusion is quite impossible, which is why we have all the outrage about where the boundaries might go. The Government keep changing their mind on what kind of structure they want for the health service and its vital community-based services. Why does not she stop, start again and try to remain consistent?

Jane Kennedy: I agree with a significant part of what the right hon. and learned Gentleman said. If I can get to it, I will explain the reasoning behind the changes that we are bringing forward. I strongly disagree with him on one thing, on which I must pick him up. The only similarity between GP fundholding and practice-based commissioning is that it involves GPs; otherwise, there is absolutely nothing in common between the two systems. Under fundholding, every GP could have a contract with any number of hospitals, wasting enormous amounts of clinical and administrative time in negotiations. Under practice-based commissioning, the PCT will hold the contract with the hospitals and the GPs will use that contract to access services for their patients. There is absolutely nothing in common between the discredited system that the Conservative party instituted and the system that we are taking forward.
	The increased investment that I mentioned earlier, together with the hard work of 1.3 million NHS staff—and I am pleased to join the hon. Member for Eddisbury—

David Heath: rose—

Jane Kennedy: The hon. Gentleman must contain himself. I will give way in a moment.
	I agree with what the hon. Member for Eddisbury said about NHS staff. That hard work is transforming our hospitals, with much reduced waiting times and lists, improved accident and emergency services and newer, more appropriate facilities to meet the changing health needs of 21st century Britain. I suppose I ought to give way to the hon. Member for Somerton and Frome (Mr. Heath).

David Heath: I am most grateful to the right hon. Lady. I simply want to speak for my local hospital. For eight years, we campaigned locally for Frome Victoria hospital and, hallelujah, only two or three months ago it was announced that we would have a new hospital, which is great news and I am grateful to the Government for that. There is now a question about whether the PCT reorganisation and the announcement by the Secretary of State for Health last week have put the capital investment that was to go into Frome Victoria hospital this year in doubt. I do not expect her to know the answer to that now, but will she undertake to write to me to reassure me that Frome Victoria hospital is going ahead as planned?

Jane Kennedy: The hon. Gentleman's persistence has paid off to the extent that I will undertake to look into the matter and write to him to address his concerns about that problem.

Several hon. Members: rose—

Jane Kennedy: I now wish to make some progress because I am conscious of the time, and I know that many Back Benchers want to participate in the debate.
	Ninety per cent. of patients' contact with the NHS is within primary care settings. About 900,000 people a day contact a GP or a practice nurse. The challenge now is to improve primary and community services. That is why last week we published the White Paper, "Our health, our care, our say", setting out our plans to do that. It emphasises that good commissioning is essential to improving services for patients. That means that the NHS needs to get better at securing the best possible services, representing good value from a growing range of health care providers. Reforms such as patient choice and payment by results mean that individual decisions to refer and patient choice will in effect drive commissioning. Patients in discussion with their commissions will choose where they want to go for treatment. Payment by results ensures that the money follows the patient to pay for their care. Once established, the payment by results tariff offers the opportunity for adaptation to encourage alternatives to hospital referral.

Gwyneth Dunwoody: My right hon. Friend is a lady of tact and intelligence and she must know that that, frankly, is a load of nonsense. The reality is that if we move towards this system, the patient will have no way of knowing the quality of surgeon in a particular hospital, and no way of knowing who has the reputation for killing a quarter of his patients and who has the best outcomes. It is nonsense to suggest that patients will have any way of knowing. What they want are good services of a uniform standard in their own area. That is what they want and this division will make it worse.

Jane Kennedy: I am sorry that my hon. Friend, whom I regard as a very dear friend, takes such a strong opposite view to me. I do not agree with her. I believe that, increasingly, patients will want to know from their GPs the recovery rates for different surgeons and how they perform, as well as how, for example, a hospital performs on MRSA. Those are exactly the kind of questions that people will be asking. Increasingly, they will be able to get the information not only from their GP, but from the internet, where more and more hospitals are providing precisely that kind of information to the patients who receive services from them.

Andrew Turner: I am particularly grateful to the Minister for giving way because I wanted to congratulate her on recognising the Isle of Wight's need for a unified PCT health service trust, covering acute, ambulance, mental health and community services. However, I wish to follow the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) by asking how can there be choice for patients on the Isle of Wight if there is no money to help them get to hospitals on the mainland. It is choice for the rich, but not for the poor.

Jane Kennedy: That is an interesting point. The difficulties of transport from the Isle if Wight would need to be taken into account and we are still developing the detail of the commissioning proposal and how the model will work. Those issues will face his constituents on low incomes—I am pleased to hear the hon. Gentleman champion them—and their interests will need to be taken into account so that they can achieve a real and genuine choice of services.
	Under practice-based commissioning, GPs and other primary care professionals—the clinicians in daily contact with patients—will be able to redesign services for their patients. All of this allows PCTs to concentrate on a more strategic role. The way we commission needs to be transformed if we are to deliver the next phase of reforms successfully. We need to make commissioning more professional and to learn from the best, and we need to encourage innovation. Above all, we need to make sure that patients have access to the right services in the right place at the right time.

Michael Wills: I congratulate my right hon. Friend on what she has said so far. Does she agree that the reconfiguration offers a wonderful opportunity, where there is local support, to adopt new commissioning models that perhaps locate all the services that patients need in one site? In Swindon, there is a great deal of support for integrating caring organisations and social services with primary and hospital care commissioning. Does she agree that there is a good opportunity here to move forward?

Jane Kennedy: I am grateful to my hon. Friend, and I agree with him.
	As with PCTs, there are clear and compelling reasons for change in the way in which ambulance services are structured. The range of care they provide is expanding, taking health care to patients who need an emergency response, providing urgent advice or treatment to patients who are less ill and providing care to those whose condition or location prevents them from travelling easily to access health care services.
	Spending on ambulance services has increased by over 75 per cent. since 1997, which has helped to bring about improvements to services. Over the past two years, the Government have met, and exceeded, the standard that at least 75 per cent. of 999 calls from patients with immediate, life-threatening conditions should have an ambulance respond to them within eight minutes. This has been achieved in spite of consistently increasing demand for ambulance services.

Mark Pritchard: I note the Minister's comments on ambulances, but might I bring her back to superbugs? Is she aware that the isolation ward at the Princess Royal hospital in my constituency closed one month ago? Does that mean that the Government believe that superbugs have gone?

Jane Kennedy: No.

Charlotte Atkins: Will my right hon. Friend ensure that the hon. Member for Eddisbury (Mr. O'Brien) understands that the reason Staffordshire ambulance service is so successful is not because of local knowledge—nowadays we have computer systems that deal with that matter—but the unique operating system that means that emergency ambulances are put where they will be needed? That unique system means that a merger of the west midlands ambulance services cannot work unless the Staffordshire ambulance service is allowed to have its operational independence.

Jane Kennedy: My hon. Friend has made a sustained and consistent case for the ambulance trust that she knows so well. I repeat that no decision has yet been taken on the consultations that are taking place on PCTs, ambulance trusts or strategic health authority reform. I have heard my hon. Friend make that point on many occasions and we are listening to the representations that are being made. We know that there is more that ambulance trusts need to achieve if we are to realise our vision for ambulance services and integrated urgent care. To do this, we need organisations that have the capacity and capability to plan for tomorrow as well as to deal with today. That is not achieved through small organisations struggling to deal with huge agendas, or through unnecessary duplication of procurement planning and support services. However, it can be achieved through collaboration and getting best value. This reconfiguration is about delivering for the taxpayer. It is about combining high-quality leadership with retaining the best of what can be delivered locally. It is not about change for change's sake.
	In the case of ambulance trusts, there was a clear view from stakeholders that the lack of coterminosity and the small size of some trusts were acting as barriers to improved patient care. This view was reflected in the recommendations of the recent ambulance service review. To achieve the change we are aiming for, we want SHAs to lead the process of reconfiguration locally. We have asked them to work with their local stakeholders, including MPs from both sides of the Chamber, and to put forward proposals for the reconfiguration of ambulance trusts, PCTs and SHAs against a set of national criteria.

Eleanor Laing: On that very point, will the Minister undertake to listen genuinely to the case being made by some local people and organisations? Some PCTs are very good and the Minister is right to say that services in many areas, such as Epping Forest, have improved. We have an excellent PCT and it would be such a pity if it were to be swallowed up in a large regional organisation and if the opinions of local people were not listened to. I am sure that the Minister would genuinely wish to listen to the people who require and benefit from the services.

Jane Kennedy: The hon. Lady argues strongly that we should listen to local people. I understand that the county council in her area does not share her view. Presumably, it also represents local people. Clearly, it will be a real effort to listen to all sides and to make sure that solutions can be arrived at that achieve the best for the patients, which, in the end, is the objective.

Brian Jenkins: I have listened with interest to what my right hon. Friend has to say, and I ask her please not to take any notice of the county councils on this issue. I do not understand the criteria or the figures on which such amalgamation is based. My PCT is one of the most expensive in my area. In terms of management and administration, it costs £27 a head for every man, woman and child in the area—a sum far greater than that applying to other PCTs in the region. I cannot understand why the Department is still pressing ahead with a PCT that will cover nearly three quarters of a million people and all of south Staffordshire, given that the average figure for west midlands PCTs is 230,000. I am not opposed to any amalgamation that improves services, but I want to know what the criteria are and how they have been arrived at, and how we can provide an effective local service for people on this scale. My right hon. Friend has yet to make the case.

Jane Kennedy: Obviously, there are one or two of my hon. Friends whom we need to work more closely with to persuade them of our case. One of the best ways to give patients more of a say in local services is to empower the health care professionals who are closest to the patients. Larger PCTs do not mean more remote PCTs. That is why practice-based commissioning is being rolled out alongside reconfiguration, giving GPs and primary care professionals more freedom to redesign better services for their patients.
	Strengthening local commissioning will mean that the money is spent in communities where there is greatest need, rather than being sucked into areas where the demand is more vocal. As was pointed out earlier, our proposed reconfiguring of organisations will strengthen relationships between health care professionals and local authorities through greater coterminosity. London boroughs and PCTs, for example, are bringing about genuine improvements in the delivery of primary and social care in the boroughs. Those improvements have been enabled by the coterminous arrangement of PCT boundaries with social service local boroughs. Currently, just over 40 per cent. of PCTs are coterminous with local government boundaries, and we expect that figure to rise to almost 80 per cent. as a result of the proposed changes in PCT boundaries.
	Ambulance trusts and SHAs are likely to see their boundaries much more closely aligned with those of the Government offices for the regions.

Andrew Lansley: Why?

Jane Kennedy: These changes will enable organisations to work together more effectively to tackle priorities such as reducing health inequalities. Conservative Members do not like to hear this because they were not interested in achieving reductions in health inequalities when they were in power.

Andrew Lansley: rose—

Jane Kennedy: I happily give way to the hon. Gentleman.

Andrew Lansley: Does the Minister recall that Peter Bradley's report said that the number of ambulance trusts should be reduced in line with SHAs, of which there are 28? The report said nothing about regions. Does it not occur to her that ambulance trusts work with hospitals, GPs, out-of-hours services and NHS Direct? When do they actually need to work with the regional offices of the Department of Health?

Jane Kennedy: The point that the hon. Gentleman makes is not really very valuable. Benefits will flow from working more closely with other structures. For example, in the event of a very large incident, emergency response is enhanced when services have become used to working together and have developed working policies and protocols. Fewer, larger ambulance trusts will also make it simpler to build the effective relationships with stakeholders that are so important in successfully dealing with major incidents, and in providing the effective delivery of integrated, patient-centred health services.
	Our aim is an NHS that is free to all of us and personal to each of us. We are delivering it through high national standards backed by sustained investment, by using new providers where they add capacity or promote innovation and, most importantly, by giving more power to patients over their own treatment and their own health. I ask the House to support the amendment.

Julia Goldsworthy: I am sure that today's Conservative Opposition day debate will give some flavour of the rapid structural changes that our national health service will go through in the coming years. The restructuring of primary care trusts has followed a very hasty timetable. That timetable was announced during last July's parliamentary recess, and the initial consultation period closed on 15 October. That is neither a long time, nor a particularly appropriate time for such consultation to take place. Let us not forget that this is the third restructuring in 10 years, and that it will reduce the number of PCTs from 300 to 100 by this October.
	Initially, the proposed changes were supposed to coincide with trusts shifting toward a commissioning, rather than provider, role. That led to outcry in this place, and to Adjournment debates initiated by Labour Members. There was also outcry from the 200,000 workers directly employed by PCTs, who suddenly did not know how much longer they would have a job, or who their employer would be. They did not know whether it would continue to be the PCT, or whether it would be a private sector charity or the voluntary sector. Following some rapid rowing back, the Secretary of State adopted a new position whereby PCTs would move to a commissioning role only as and when they decided to. However, the chief executive of the NHS has not formally withdrawn his reference, contained in his initial letter, to the 2008 deadline by which PCTs should move over fully to a commissioning role. I should be very grateful if the Minister clarified that contradiction.
	There is still a lack of clarity as to the future function of our PCTs. However, the rationale behind the new structure seems clear: it is not a one-size-fits-all approach, but a case of "any size, so long as it's bigger". This approach constitutes a move away from the rationale employed during the previous restructuring of PCTs, which took place only three years ago, whereby greater connection was sought with local communities. Only an "any size, so long as it's bigger" rationale can explain why London's PCTs are expected to move from a structure that already provides coterminosity with social services to being even bigger beasts, while Cornwall looks set to have its three PCTs reduced to just one. That is indeed a move towards coterminosity, with local authorities providing social services; then again, the existing structures are under review, so the local authorities may in any event change shape. Their future remains in some doubt.
	As if this dog's breakfast were not enough, ambulance trusts are also up for reconfiguration. The intention is not to improve services to the public, but to fit the "any size, so long as it's bigger" mantra by reducing the number of ambulance trusts from 31 to 11.
	Ignoring the principle of not fixing things if they are not broken, it seems that even the best-performing ambulance trusts—such as the Staffordshire trust, which has a three-star rating and is the highest performing trust, according to Government targets—are likely to be merged. As the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) said in her earlier intervention, it is not the size of the trust that determines how well it performs—and is there any point in fixing something that is not broken? Surely the emphasis should be on co-operating and sharing best practice with other trusts, rather than on introducing the concept of contestability, which will put trusts in competition with one another.
	If the principle is to apply to PCTs and ambulance trusts, SHAs must automatically follow suit, according to the "any size, so long as it's bigger" mantra. They must go through similar upheavals, with the changes to be completed by April 2007.

David Heath: Does my hon. Friend agree, given her experience in her own area, that PCTs had a difficult task in dealing with rural areas in particular, and that some have made a superb job of it? Mendip PCT, in my area, has really got to grips with delivering primary health care in a rural area. It is a great shame if that is now to be put at risk by reorganisation—by putting the PCT into a bigger structure that simply will not have the same feel or be able to cope with the difficulties of scale associated with rural areas.

Julia Goldsworthy: I thank my hon. Friend for that contribution, and that is certainly the feedback that I am getting from my constituents. In the past, there has been a very good relationship between the local PCT and the services offered. There is real concern that a move to a bigger authority will lead to the loss of links that have been built up in the past few years, and that that will have a detrimental impact on the services provided. However, only one proposal—for a single primary care trust—has been put forward for consultation, and the argument is that it will provide a more strategic role. If that is the case, why would we continue to need a strategic health authority?
	The changes do not stop at PCTs, ambulance trusts and strategic health authorities. Other significant changes will kick in this year, including payment by results, practice-based commissioning and even the new dental contracts, which are all closely interrelated with the changes in the structures. Sir Nigel Crisp was not kidding when he said:
	"2006 will be an important transitional year for the NHS."
	That is possibly the understatement of the year.
	When I talked with the chair of an NHS trust in my constituency last week, the point was made—the Minister made it again today—that this is not a time of evolution for the NHS, but a time of rapid and continual revolution. It is unclear what the NHS will look like when we reach the end of this year. A series of potentially destabilising changes will take place simultaneously in an already uncertain climate, in which a quarter of NHS trusts already have to deal with deficits. The impact of many of the changes, even if taken in isolation, is largely unknown because many have not been properly piloted. There has certainly been no piloting of the possible cumulative impact of the changes.
	For example, payment by results will start in the next financial year, but concerns are already being raised about the tariff levels for some operations. In Norway, a system of payment by results was introduced at 60 per cent., not for 100 per cent. of care, and it was seen to create perverse incentives, so it was scaled back to 40 per cent. But this Government think that the best approach is to introduce 100 per cent. payment by results straight off, and damn the consequences—even if that may create even greater financial insecurity and instability for many trusts already struggling with deficits, and even if it will lead to incentives to give every headache patient a CT scan to add to their treatment. Such perverse incentives are like the small butterfly wings flapping that create a hurricane further down the line.
	Another example of inadequate piloting before rolling out the changes can be seen in the new dental contract. We will not know what the impact of the new contract will be until it rolls out across the country, but I know from surveying dentists in my constituency that about 75 per cent. are thinking of leaving the NHS altogether as a result. That is another unknown factor to be added to an already unstable and high-risk situation. The changes look increasingly like ingredients for a rushed recipe for disaster.
	Why the hurry and impatience from the Government? After all, they have had eight years to formulate a solution. Is it the funding time scale of increased investment in the NHS, and the looming end to increased investment in 2008, that is causing the panic? If the changes are not in place and bedded down by then, is their future success even more in doubt? Or is it the hurry to find those pesky efficiency savings demanded by the Gershon review? If so, it would explain the "any size, so long as it's bigger" rationale.
	Will the savings be real, or will many of them be lost in setting up and branding the new structures? Given that many PCT mergers will have to take place in mid financial year, has the Department made any assessment of the extra costs of having to file two separate accounts, or any of the other transition costs that will result from the changes?
	It is clear that it is not the wishes of the public that are driving the changes. That is evident from the amount of time given to consultation on the changes—and often from what proposals are put forward for consultation. As I said, in Cornwall only one proposal for a single primary care trust has been put forward for consultation, so there is no choice of options for the local people.
	The Secretary of State's own consultation in Birmingham also showed that the Government's priorities for the NHS were not those of the invited public. The citizens summit in Birmingham last year showed that the public were not interested in improving contestability or even the choice agenda—especially in rural areas, where getting to the local hospital is already enough of a struggle for most people. What they were interested in was increased GP opening hours and out-of-hours provision, which the Government did away with in the most recent contract negotiations. Whatever the priorities of the public—indeed, in spite of their needs and priorities—the changes continue to be pushed apace.
	The irony is that at the end of all the changes—three upheavals under this Labour Government—we will be back almost exactly where the NHS was when Labour came to power. Bigger primary care trusts will have become like the health authorities, strategic health authorities will be more like the regional authorities that Labour abolished, and GP fundholders will have become practice-based commissioners. What is even more ironic is that the Conservatives oppose the proposals that will take us back to the last days of their Government.
	Greater local democratic accountability could provide better mechanisms to reflect and serve local needs and bring the accountability for underperforming trusts closer to home, rather than centralised up to the Secretary of State. Instead of pursuing and pushing forward contestability at all costs, when the regulatory framework is undeveloped and in some cases gives private providers an unfair advantage, surely trusts would be better served through greater co-operation and sharing best practice.
	The Health Committee, in a recent report, described the changes that have been undertaken since Labour came to government as an
	"ill judged cycle of perpetual change."
	This year and future years represent a time of change and an exposure to huge risks for many NHS bodies. That in turn represents great uncertainty for NHS staff and patients alike. It is time for the Department of Health to take greater account of the needs of the public rather than the steamroller of centralised reform, which takes no account of the need for locally accountable bodies to lead locally appropriate reform and locally appropriate provision for our health services. Bigger is certainly not always or automatically better.

Several hon. Members: rose—

Madam Deputy Speaker: Order. I remind right hon. and hon. Members that Mr. Speaker has imposed a 10-minute limit on Back-Bench speeches.

Bob Blizzard: I suspect that most hon. Members will want to speak tonight about the reorganisation of the primary care trusts. I must say how good it is to have PCTs in the first place. Most hon. Members will wish to support their local PCT, and I suspect that that support is based on the fact that they are local, because that is their great strength. They are able to focus the NHS on a local area, more accurately assess local need, and receive fair funding provision based on applying the formula to a precise local area. They can also develop good local relationships with GPs, pharmacists, other providers and the voluntary sector. They can be held to account locally by local stakeholders, not least patients and hon. Members.
	Waveney PCT, which serves my area, is the best thing that has happened to that area organisationally. However, with the introduction of GP practice-based commissioning, mergers are necessary. In determining the new configuration, we should apply the same principles that I have just given as the benefits of PCTs, so that the merged bodies can effectively focus on and serve a local area. For my area, that has to be a merger between Waveney and Great Yarmouth PCTs.
	I have mentioned Great Yarmouth PCT, so I must declare an interest in that my wife works for it. However, my wife long ago gave up calculating what might be the consequences for her of NHS reorganisations in our area, because she has been reorganised four times in the past 10 years. We can all agree that we could do with less reorganisation in the NHS, but my area has had at least one positive result from all the reorganisations we have had, in that clear lessons have been learned about what works and what does not work in the area. We know that county-wide NHS organisation does not work for my constituency, but the Great Yarmouth and Waveney combination does. When we had Suffolk health—

John Gummer: Does my constituency neighbour agree that it is a remarkable fact that the other part of Waveney covered by the PCT is in my constituency, and we agree entirely that it should be amalgamated as he suggests? Did not it take much effort to get the authorities even to allow that alternative to be discussed, and is that not the problem with the consultation?

Bob Blizzard: When the right hon. Gentleman and I, and every strand of clinical opinion in our area, are in agreement, the SHA and the Secretary of State should listen.
	Before I was elected, the provision of resources under the Suffolk health authority did not meet the needs of my area; we merely received a share of the Suffolk average and the needs and deprivation in our part of the county were not taken into account. That organisation was remote and out of touch. It instituted locality management, but that negated the savings that it claimed would be achieved. We ended up with bad relations between the health authority and the community, and even worse relations between the health authority and the medical professionals.
	Fortunately, our Labour Government created Waveney primary care trust. I thought we had won and that we had been delivered from the unbearable. Since the trust was created, Waveney has worked closely with Great Yarmouth, even sharing the same chief executive for a time. Before the last election, it was clear that there would be mergers and everybody in our area expected that the natural merger would be between Great Yarmouth and Waveney. In fact, the strategic health authority encouraged that, recognising the area as a discrete performance unit for things such as the roll-out of the national programme for information technology. When Sir Nigel Crisp's letter arrived last July, asking PCTs to come up with proposals, everybody locally thought that Yarmouth and Waveney was a no-brainer, and the other PCTs in the respective counties were comfortable with that.
	Some time last summer, however, another message came from the centre, which seemed to be talking about county-wide PCTs—the proposal that the SHA made to the Secretary of State, despite representations against it. Because of the strength of our cross-party case and the willingness of the Secretary of State to listen, we now have two options, and there is no doubt that the Yarmouth and Waveney proposal is the healthy option. Those neighbouring areas have similar characteristics, including deprivation factors and health inequalities. They are both very different from their respective counties, from which they are relatively isolated. We share the same general hospital—the James Paget hospital, a three-star trust that is about to achieve foundation status. We have a natural health economy; the two PCTs have for some time undertaken joint working on cancer networks, emergency care and the implementation of National Institute for Health and Clinical Excellence policy, and share some services and a director of public health.
	Yarmouth and Waveney has sub-regional status in the eastern region, and the Office of the Deputy Prime Minister has recently created an urban regeneration company spanning the two areas, part of whose remit is a public health agenda to overcome deprivation. The company wants to work with a Yarmouth and Waveney PCT rather than dealing with the separate counties. Both trusts are performing well, with two-star ratings—the best in the area. Yarmouth's budget is in balance. Waveney's budget is close to balance, and KPMG concluded that the trust would be out of deficit next year. Most important, the two PCTs work closely with GPs; there is a 100 per cent. sign-up to practice-based commissioning, which will not happen under a county-wide PCT.
	A Yarmouth and Waveney PCT would have to work with the two county council social care departments, but that is not a problem. It is already happening; both councils organise their social care on a locality basis, each matching the Yarmouth and the Waveney PCT areas. There is already a strong record of partnership, with joint and developing initiatives, integrated management arrangements and integrated services under section 31 agreements, and each county leads for the other; for example, Norfolk provides social care services for Suffolk at the James Paget hospital. Social care is not a problem, and as those departments become less and less of a provider, patient choice will take patients from my area across the county boundary.
	The proposed PCT would be large enough to realise economies of scale. The required savings of 15 per cent. could be made, but the PCT would be sensitive enough to know and meet local needs. However, I question whether, faced with the two options—the one that the SHA put to the Secretary of State and the one that the community and its representatives put to the Secretary of State—the SHA is behaving neutrally. We have some concerns. In the consultation document, the SHA said that the Yarmouth and Waveney option would
	"inhibit the development of practice-based commissioning".
	The people who know—GPs—wholly contradict that; they say that the county-wide option would inhibit that development. There were questions about size, but smaller PCTs in other parts of the country are proposed as single options. We should not fall foul of the size rule.
	Will the Minister confirm what was said to me in letters from the Secretary of State and from Lord Warner? I was told:
	"There is no standard, national template. The proposals could be based on large or small PCTs, providing that they deliver what is required locally, including a stronger commissioning capability."
	I fear that our SHA has a template based on the county model, so I hope that my hon. Friend will reassure us that that is not the view of the Department or the Secretary of State.
	Finally, will my hon. Friend keep faith with local people and their representatives? The option that I have proposed is supported not only by me, my hon. Friend the Member for Great Yarmouth (Mr. Wright) and the right hon. Member for Suffolk, Coastal (Mr. Gummer), but by Waveney district council, Great Yarmouth borough council, the two PCTs, the James Paget Healthcare NHS Trust, the patient and public involvement forum, all the GPs, the Lowestoft and Great Yarmouth urban regeneration company and the local strategic partnerships. It is hard to find anybody locally who does not support the proposal. Will my hon. Friend keep faith with the local community and the medical professionals who serve it? The proposed PCT would be the people's PCT. A Great Yarmouth and Waveney PCT would make the reforms in commissioning a patient-led NHS work, but I fear that if we take the other option those reforms could fail.

John Gummer: I entirely agree with what the hon. Member for Waveney (Mr. Blizzard) said, and commend him for it. The joint cross-party arrangements show how strongly we feel. I have to depart from the hon. Gentleman, however, when I talk about the strategic health authority. Five Members of Parliament for Suffolk invited their SHA to answer a series of questions, as you will know, Mr. Deputy Speaker, because you were there. The questions were answered in two ways: the SHA could not help, either because the decision was a Government one or because it was a PCT one.
	There was no question to which the SHA replied, "Yes, we can do that." It cannot do anything. There is no known position on which the SHA contributes at all. Unfortunately, it has not done the one thing it should have done—overseeing the PCTs to ensure that they did not get into the debt they are now experiencing. The fact that the SHA was unable to do that shows that SHAs have no purpose whatever.
	My PCT is very much in debt, as are all the Suffolk PCTs except Waveney. One of the reasons for that debt is that on average, under the funding formula, for every 100p, we receive 90p, while Manchester receives 124p, yet we have a high proportion of old people. The formula hits us strongly; it is not entirely overspending but underfunding that has contributed to the debt.
	The unfortunate changes in the way that the funds are doled out have hit rural areas with large numbers of old people. Because of those numbers we used to receive sufficient funding, but that is no longer the case. Labour Members say that we do not have the hospital closures that used to take place, but there are two in my constituency: a full closure in Felixstowe and a half-closure in Aldeburgh. That has happened since the election.
	Interestingly enough, before the election, we were told that a reorganisation would take place and a perfectly reasonable plan was proposed that would improve patient care. I supported that plan. I took the chair of the meeting to encourage people who had doubts about it that that was the reasonable thing to do. Immediately after the election, it was announced that that plan was no good and that those involved had found a new model of patient care. That happened in two months—it was a very clever, speedy change—and during that time, the PCT announced that their new model patient plan involved the closure of one hospital and the halving of the other. That was an interesting decision, but we were told that it had nothing to do with money or the general election. I found that most of my constituents were unable to take that quite as literally as it was put.
	The problem is that my constituents see a model of care that makes the NHS in my area worse than it has been for 30 years. So I thought that I would ask the Minister a series of simple questions. About a fortnight ago, I asked when the financial and management specialist team would report its findings. I just asked for the date. The answer from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) was:
	"I shall reply to the hon. Member as soon as possible."
	I then asked how many people made up the team and how many days they spent investigating, and the answer was:
	"I shall reply to the hon. Member as soon as possible."
	I then asked what representative bodies the group discussed things with, and the answer was:
	"I shall reply to the hon. Member as soon as possible."
	I then asked the Secretary of State for Health:
	"what sanctions are available to her against a primary care trust and its board members should poor administration be found by the financial and management specialist team."
	Anyone would think that she ought to know that, but the answer was:
	"I shall reply to the hon. Member as soon as possible."
	I then asked:
	"will she require the NHS Appointments Commission to change its policy of reappointing chairmen and non-executive members of primary care trust boards where those appointees have presided over trusts that are failing or under investigation."
	The answer was:
	"I shall reply to the hon. Member as soon as possible."
	The Minister could have said, "Yes," "No," or, "I'm thinking about it"—but no, there is the same cursory attitude to Members of Parliament who seek information as there is to local people when they go in for consultation. The consultations are a sham, and the only intention is to reach the same conclusion as the Government have decided on anyway. To reappoint to my failing PCT the same people who have presided over the debts, which must now be paid by patients in my constituency, is a scandal.

Shailesh Vara: My right hon. Friend says that the consultation process is a sham. Huntingdonshire PCT has already been informed that some £12 million to £13 million will be taken away from its budget in the 2006–07 financial year. Does he agree that that clearly reflects the fact that this is a sham?

John Gummer: I cannot speak about Huntingdonshire, but it is clearly a sham when we always have the same answers. Let us take the regionalisation of the ambulance service. Is it not amazing? We ask those in the charge of the police, and curiously enough, they suggest the regions as the natural way of policing. We ask people about the fire service, and curiously enough, a whole lot of other people make exactly the same proposal—that for the fire service, the region is the ideal unit. We then ask the ambulance people—well, we do not ask too many of them, but we ask those who might come to an answer—and what do they say? Surprisingly enough, they think that the regions are the answer. We then to the SHA, and it says that regions are the answer. Regions are the answer because the Government want them to be the answer, not because anyone inside those organisations thinks so.

Michael Wills: I want to clarify something about ambulance trusts. Earlier, the hon. Member for Eddisbury (Mr. O'Brien) said that only ambulance trusts should decide whether they undertook managerial reform. Does the right hon. Gentleman agree with him?

John Gummer: I agree with what my hon. Friend said during the rest of his speech as well, which was that we should at least listen to the ambulance trusts and to others around them. It all seems very peculiar, when none of the ambulance trusts have campaigned for regional operation.
	I then asked the Minister about dentists. I said that I could not find any dentists for my constituents in the southern part of my constituency and asked him to tell me where they could be found. He sent a letter back and said, "I rang up NHS Direct and here is a series of dentists." I looked at them. Half of them no longer took NHS patients or had closed their books, and the other half of them were in Frinton. He had not noticed that there is a river between us and Frinton, so instead of the dentists being 10 miles away, they were 45 miles away, unless people can swim. That shows the Government's understanding of my locality. It was a rude letter, too, because it suggests that I could have found out the information for myself—and I probably should have done that, given the sense and intelligence of the answers that I received from the Government.
	The Government are now going back to the same pattern as the one that they abolished three years ago in many of the areas that they are talking about. As was suggested by the hon. Member for Falmouth and Camborne (Julia Goldsworthy), who spoke for the Liberal party, the Government are demanding "anything, so long as it's bigger"—I am not sure that she is quite right—unless they can make it a region, when the region is the answer.
	The Government are also demanding that we should take seriously their definition of PCTs. PCTs are nothing other than the creatures of the Secretary of State, but she is busy pretending that if the PCT loses money, it is nothing do with her, nothing to do with the control from the centre and nothing to do with the SHA. She says that that is to do with the PCTs. So the Government reappoint the people who made the mistake and fine the locality for the mistake that has been made, because those sums must be found in so short a time that no sane organisation would possibly consider doing so.
	I thought that I would find out whether any Minister at the Department of Health had ever run a large organisation, and I find that none of them has done so. There is not a chief executive of any major company, nor even a chief executive of a Government organisation among them. All they have run are things that other people have decided on, and they are now asking us to believe that we should blame the PCTs for the mistakes that have been made by central Government, when those mistakes have been made necessary because central Government have fiddled the funding formula, so that in many areas, particularly in the south and south-east, we are underfunded.
	We are therefore asked to be serious about consultation. My local PCT has now consulted on three separate ways to deal with the problems of my constituency in less than 18 months, each of which is dramatically different, and we are told that each has been proposed entirely for clinical reasons. I do not believe that; no one in Suffolk believes it; not even the local Labour party believes it. The only person who does believe it is the hon. Member for Ipswich (Chris Mole), who is looking for a job. No one else believes it.
	I therefore went to see the Minister of State, the hon. Member for Doncaster, Central—a person whom I respect—and she turned half way through the meeting to the SHA representative and said, "Well, none of these new changes will come in until they're ready, and when they're ready and they take over, then we'll close the hospitals." She was told, "Oh no, you're wrong, Minister: we close the hospitals first, because we haven't got the money to make the changes."
	What are the changes? They are to ask for care in the community. We still do not have sufficient people to carry out care in the community now, without the changes. There are no more people to do that work in Felixstowe and Aldeburgh and along the coast that I represent—and if I may say so, Mr. Deputy Speaker, as you are unable to speak, in your constituency next door exactly the same is true. Those who can pay cannot find people to do that work, and we must try to pretend that the poor in my constituency should be faced with an inferior service because money must be saved to pay for debts that now stretch back for years.
	I find it impossible to take seriously the Government on the health service. Those of us who represent constituencies such as mine know that the Government have presided over the worst changes to the health service that we can remember. I have represented my constituency for nearly 30 years, and now know that the health service that the Government leave will be significantly worse than the one that I was able to welcome when I was first elected to the House.

Eric Martlew: I did not really take seriously what the right hon. Member for Suffolk, Coastal (Mr. Gummer) said. I remember when he was Minister of Agriculture, Fisheries and Food and his Department was a shambles. I was surprised that he said that there had been no improvement. Anyone who has been a Member of the House for any period of time—new Members can be forgiven—will remember the letters that we got about waits for hip replacements of two, three or four years. That does not happen anymore. Although we have a problem with dentists, there have been massive improvements. When people ask where the money has gone and why productivity has not increased, the answer is simple: a lot of money had to be used to pay the staff a decent salary because they were underpaid under the Conservative Government—I sometimes wish that the staff would remember that, too. The reality is that we now have a lot more nurses and consultants.
	I welcome the opportunity for the debate that the Conservatives have given us, although they cannot be taken seriously because when we debated extra money for the NHS—the penny on national insurance—they voted against it. Conservative Members may say that their PCTs are in trouble, but they really would have been in trouble if the Conservatives had won that vote.

Paul Truswell: Does my hon. Friend agree that Conservative Members have a brass neck when it comes to talking about changing the NHS? He has been a Member for longer than me. Does he remember the hugely expensive chaos that was caused by so-called general management, when our area got the manager of a biscuit company to run the NHS? The family practitioner committee became the family health services authority, and that authority amalgamated with the district health authority. The district health authority was then split between three provider trusts and a commissioning health authority, but the commissioning function was then divided between a health authority and a family health services authority. Are we not hearing absolute doublespeak from Conservative Members?

Eric Martlew: I remember that well. My only caveat is that the biggest employer in my constituency is a biscuit factory and its manager is very good.
	I would like to talk about the situation in the north-west and Cumbria. I must say from the outset that we have had too many reorganisations, so I hope that we get this one right. I was a young member of a city council back in 1972 when the ambulance service was part of the local authority, but I do not know whether Conservative Members advocate going back to that situation. Of course, the service was then taken into the health authority, but we must have had eight or nine serious reorganisations since then. I agree that reform is needed because last time it happened in our area, it was not done very well.

Bob Spink: While the hon. Gentleman is talking about massive changes due to reform, is he aware that Essex strategic health authority is trying to remove the excellent cancer centre from Southend hospital? Does he agree that there can be too much change to, and meddling with, NHS structures without any clear purpose or evidence that it will improve service levels and outcomes, which should be our aim?

Eric Martlew: The hon. Gentleman wanted to get that in. I have got to know him well over the years and suggest that one reason why he lost his seat at one election was the way in which the Conservatives ran the NHS.
	Let me come back to the serious problems caused by reorganisation in Cumbria. In 2002, I wrote a letter to the chief executive of the North Cumbria health authority, who has now retired. I said that the proposals being put forward for my area—the hon. Member for Falmouth and Camborne (Julia Goldsworthy) used this term—were a "dog's dinner".

Keith Vaz: The hon. Lady said, "Dog's breakfast."

Eric Martlew: My hon. Friend is right.
	I said at the time that it was nonsense to create three PCTs in the area of north Cumbria, which used to be Cumberland, for its population of 350,000, but that was what happened. One of the PCTs covered fewer than 70,000 people. All the other north Cumbria Members disagreed with me, as did all the district councils and the county council, but in 18 months, instead of having three management teams, it was decided that there would be one management team and three trusts. We thus have the nonsense at the moment of having three chairs of trusts—one for west Cumbria, one for Carlisle and one for Eden—and those trusts' non-executive members, but one management team. It cost millions of pounds to make the change, but it caused tremendous confusion about which PCT was responsible for which service because, for example, Carlisle and District PCT could end up being responsible for services in west Cumbria. That is why I support the reorganisation.
	Cumbria and Lancashire strategic health authority has come up with a solution, but unfortunately it is not the easy one, which would be to keep Morecambe Bay PCT, which is working well and covers the south of the county and part of Lancashire, and create one PCT for north Cumbria. Instead, it has decided to use the county boundaries and go for a county-wide PCT. I accept from Conservative Members that that is basically what the Government want, rather than a reasonable rationale.
	Anyone who knows Cumbria will realise that it is vast. Its two centres of population are my constituency of Carlisle and Barrow-in-Furness. Those places are 90 miles apart and have little to do with each other, yet it is suggested that we create one PCT for the area. However, everyone knows that two-tier local government is to be reformed, so we could end up in three years—this is a 50:50 bet—having created a PCT for Cumbria that is not conterminous with the new local government boundaries, which would not make any sense.
	The Home Secretary announced yesterday that Cumbria is not really that important because its police service will be in with that of Lancashire—I do not have major worries about that. The ambulance service will be merged, too. I have been to see the chair of my local ambulance trust and the chair of the control. They are not concerned because they believe that being part of a big consortium will create greater buying power, so the service will be able to get the equipment that it has been lacking under the present scheme and thus be brought up to the standard that exists in the rest of the north-west. I do not buy the idea that there is an issue about mergers. If it was left to some hon. Members, we would still have the old county borough of Carlisle ambulance station. We have to think about saving money.
	We need a PCT in the north of Cumbria and the one at Morecambe bay. We also need—this was mentioned by my hon. Friend the Member for North Swindon (Mr. Wills), who is no longer in his place—to take that process further. The acute trust should manage the community services and, eventually, the social services. We should have a care trust in the north of the county. That works well, as a pilot scheme in Northumberland has shown.
	We will end up with another unsatisfactory situation, and we will reorganise again. We do not want any more reorganisation. It is not necessary; it costs money and on many an occasion it has cost us talented people.
	The right hon. Member for Suffolk, Coastal mentioned the problem of rural areas. In north Cumbria, the population determines that we have one district general hospital, but because of the geography, that population is split between Carlisle and the west coast, so we need two. We find it very difficult to manage with the moneys that are available. Governments of both parties have ignored that. There used to be a thing called the RAWP, or resource allocation working party, formula—only two people understood it, and one of them was mad—and that never gave us adequate money. We welcome the extra resources from the Government, but I feel, and I may be alone among north Cumbria's MPs, that they have got it wrong. I felt that last time, and I was right then.

Michael Fabricant: The hon. Member for Tamworth (Mr. Jenkins) said that he has no objection to his PCTs merging, as long as it provides a better service, but he is concerned about the criteria for such mergers. I agree with him.
	I am not here tonight to talk about the South Staffordshire PCT; I am here to talk about the merger of the Staffordshire ambulance service. A few months ago, a friend of mine, a youngish guy, went jogging round Whittington, a village in my constituency. He felt sick. He did not know what was wrong with him. He went home, took a shower and started feeling worse. He went downstairs and suddenly thought, "There's something seriously wrong." He dialled 999 and then collapsed.
	All Staffordshire ambulance service staff are paramedics; in fact, the service was the first in the United Kingdom to employ paramedics. The ambulances are strategically placed, controlled by global positioning system satellites, which Staffordshire was also the first to introduce. So the ambulance arrived within five minutes, and the paramedics defibrillated my friend. They gave him an injection of decoagulants and he was taken to Burton hospital; he survived. If that had happened in the west midlands, he would undoubtedly have died. The simple fact is that the response times in the west midlands are far worse than those in Staffordshire. In fact, Staffordshire enjoys the fastest response times not just in the United Kingdom but in the whole European Union.

Robert Flello: Will the hon. Gentleman give way?

Michael Fabricant: I will give way to a fellow Staffordshire Member of Parliament.

Robert Flello: Will the hon. Gentleman mention also that, of all the ambulance services, Staffordshire probably uses the most anticoagulant drugs to good effect?

Michael Fabricant: The hon. Gentleman is absolutely right. In fact, the service's use of those drugs is beyond the normal clinical protocols for the national ambulance services. Staffordshire ambulance service can also provide angioplasty, and through cardiac enzyme testing, which is generally not available elsewhere, it can manage patients with chest pain who are not transported to hospital. There is even a cooling protocol for those with post-cardiac arrest, to stop brain damage and other tissue damage. That is unique, yet the Government, either wittingly or unwittingly, are to destroy it.
	The response to life-threatening emergencies within eight minutes in Staffordshire is a staggering 88 per cent. The NHS average is only 75 per cent. In the east midlands, where there has been a merged ambulance service, it is only 75 per cent. These are Department of Health figures. For category B, which are serious emergency call-outs, in Staffordshire the response is within eight minutes 85 per cent. of the time. In the west midlands it is only 46 per cent. of the time, and in the east midlands, the model for a regional system of ambulance services, it is only 27 per cent. of the time. Any doctor will tell you that time is life. There is a golden period in which, perhaps, someone can be rescued from death. The Staffordshire ambulance service succeeds in that while other ambulance services fail.
	I suspect that the Minister will say that, if Staffordshire ambulance service is merged with the west midlands, standards throughout will be raised. I do not think so, and nor does the board of the Staffordshire ambulance service. Members of the board say:
	"Our concerns are that there is little, if anything, in the documents to explain how high performance will be protected.
	Staffordshire consistently responds quicker, saves more lives from cardiac arrest and heart attacks and operates a cheaper response to emergency patients.
	Discussions within the West Midlands region lead us to feel more, not less, alarmed at the prospects of standards falling, and of lives being lost which otherwise would have been saved."
	All of us as Members of Parliament have a duty of care to our constituents. What can be more important than standing up in this House and trying to do something to stop the unnecessary loss of our constituents' lives? Amazingly, it is estimated that, if other ambulance services adopted the practice of the Staffordshire ambulance service, some 3,000 extra lives a year in the United Kingdom could be saved.
	Yet, are the Government saying, "Yes, we will preserve the Staffordshire ambulance service and we will use its protocols across other services"? No, they are not. The Minister gave it away in her introductory speech. She said that the object of the exercise is to provide a regional-based system—but why? If it were a regional-based system that could improve response times, that would be fine by me. I would not care if a regional system were best. If it were larger than a region, that would be fine. I am interested in only one thing, and that is a better service for my constituents. What is clear from looking at the east midlands model and from listening to the professionals in Staffordshire and, indeed, in Birmingham and the west midlands as a whole, is that the fine, high standards maintained in Staffordshire would be lost, and that that would result in lives being lost in Staffordshire and elsewhere.
	The irony is that the Government may be concerned solely with saving money, but Staffordshire ambulance service is the most cost-effective service in the country. It says:
	"To our knowledge, there are no services of the proposed size anywhere in the world that achieve high performance"
	as the Staffordshire ambulance service does. We should be rejoicing in this Chamber; the Minister should be saying, "We are proud as a Government that we have achieved that in Staffordshire, and we want to repeat it elsewhere." The Staffordshire ambulance service goes on to say:
	"We would argue that the creation of eleven regional services is not only a step too far, too soon, but a barrier to high performance."
	I agree.
	The figures are clear; the lives saved are indisputable. If the Staffordshire ambulance service is merged with the   west midlands, lives will be lost. They will be unnecessarily lost and this Government will be to blame.

Paul Farrelly: After listening to the two opening Opposition Back-Bench speeches—that of the right hon. Member for Suffolk, Coastal (Mr. Gummer) and the moving contribution of the hon. Member for Lichfield (Michael Fabricant)—I hope that the Minister will not groan at a similar refrain in the latest instalment from Staffordshire.
	From previous plain-speaking encounters, the Minister and the Secretary of State will be well aware of what a prickly subject ambulances and PCTs are in my constituency and the whole of our county. However, like my hon. Friend the Member for Carlisle (Mr. Martlew), before I come to the thorny issues I will accentuate the positive. I shall not reel off reams of statistics, but spending on the NHS in north Staffordshire has almost doubled since 1997. Like for like, it has increased from £267 million in 1997 to £521 million today—a 95 per cent. increase. There is not a single MP who has not seen the benefits of such investment through their constituency casework—shorter waiting lists, fewer complaints about delays in treatment and even the odd thank-you once in a while.
	In north Staffordshire, we also have a new medical school in partnership with Keele university. New health centres are bringing better NHS care right to people's doorsteps in Newcastle, as elsewhere in the country. Of course, not everything in the garden is rosy. Like any company, a huge organisation such as the NHS always faces challenges in managing that investment, not least in the face of constant organisational change. The PCTs in my area and the university hospital of north Staffordshire face varying degrees of deficit, despite the increase in spending. That is a pressing management issue but it is important to keep the scale of the problems in perspective. There should be no short-term panic measures conflicting with investment to meet long-term need.
	In our area, we were happy to hear from the new management at the hospital last week that plans for our brand-new hospital remain on track—and rightly so, if I may be partisan for a moment as we approach the 100th anniversary of the parliamentary Labour party. The hospital is the single most important investment ever promised by a Labour Government to an area that has stuck with Labour through lean and fallow, through thick and thin.
	Aside from painful decisions about costs and deficits, there is little more disruptive and demoralising than constant, continual reorganisation, not least when the benefits are unproven, the perception is of change for change's sake, and the end result may be a reduction in standards, a loss of responsiveness and a more impersonal service in our much-envied NHS. That is where we stand in Staffordshire in respect of proposals to merge the county ambulance service into one super-organisation in the west midlands covering over 5 million people and over 6,000 square miles in all.
	My hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins), as well as the hon. Member for Lichfield, referred to the ambulance service. My hon. Friend and neighbour has done sterling work in leading the call for the Staffordshire ambulance service to remain just as it is. She is representing the concerns of her constituents in the border towns and villages of the most northerly part of the west midlands region about a reorganisation that will see yet another HQ based in Birmingham.
	Those concerns about local responsiveness are shared by people in my border villages—I will be in hot water if I do not name them all—Audley, Bignall End, Wood Lane, Halmer End, Alsagers Bank, Scot Hay, Miles Green, Betley, Balterley and Wrinehill in the constituency of Newcastle-under-Lyme. Over 3,000 residents from the villages signed a petition that I presented to the Secretary of State before Christmas. Many of them turned out last night, too, at a packed public consultation meeting in Newcastle about the changes, to support the continued operational independence at the very least of the Staffordshire ambulance service. That is a political translation of, "Hands off our ambulances."
	I shall not repeat all the arguments made so well by my hon. Friend and neighbour, but I shall give one short anecdotal example, not necessarily to compete with the hon. Member for Lichfield, but to exemplify the common-sense concerns that people have. Fortunately, I have had the need to call an ambulance only twice in my life. The first time was at a funeral in Newcastle about two years ago, when the emotion was too much for one elderly person. He collapsed with a heart attack. I and other people called 999 and got straight through. The ambulance, stationed on a street corner, arrived within four minutes and the paramedics undoubtedly saved his life.
	The second occasion was for an emergency with my family here in London before Christmas. In the early hours of the morning, I called the London ambulance brigade not once, not twice, but three times. Each time, I was held up at the call centre with the same pre-recorded message: "We apologise. We are experiencing unprecedented demand for our services." When I got through the third time, the operator told me that they had no record of the first two calls—"Probably because we get so many hoaxes," she said. The air, I am afraid to say, by this time was blue. That is one of the reasons that I have not complained. I would be very embarrassed to listen to the tape recordings. We got to the hospital eventually by minicab. I know that that night, the London ambulance service did not return calls to my mobile and no ambulance ever arrived at my house.
	I cannot draw conclusions from one experience, but I can well understand from that experience the plain, everyday concerns of local people in Staffordshire. Those concerns are heightened by the fact that, despite the widespread campaign in the west midlands by our strategic health authority, there is only one option on the table in this consultation, and we are all politicians enough to know what a shortlist of one really means. We need guarantees about the operational independence of Staffordshire ambulance service.
	Primary care trusts are the bodies that we set up just over three years ago to make the NHS more local, more responsive and therefore, in everyday terms, more efficient in meeting local needs. Here, I am glad to say that we have had more success, with the Department's help, in making the consultation more meaningful. Instead of just one option, we have two: one for the whole of Staffordshire bar Stoke-on-Trent and one, bringing me even closer in my tryst with my hon. Friend the Member for Staffordshire, Moorlands, for a merger of our two local PCTs.
	That was not arrived at without a struggle—a bare-knuckle fight would be a better description. I must acknowledge the help of Ministers in the Department, who had to remind the SHA of its duty to be fair and balanced in consultation. Nevertheless, as appeared to be the case in Waveney and Great Yarmouth, it had to be dragged kicking and screaming. It was not good enough to sing the praises of option 1—the super-sized approach—while adding a grudging PS in the first draft of the document: "By the way, here's option 2, which all the local people, voluntary groups, professionals and medics in north Staffordshire support, but we think is rubbish."
	I hope that that is not the end of it. Colleagues in the south and east of the county are also balking at being thrown into one super-PCT, and we will support them as they develop their proposals. One of the non-sequiturs used by the proponents of a super-sized PCT for the whole of Staffordshire is that outside the northern sub-region, which is identifiable in its need, there is no coherent health community. That is clearly designed to set one part of the county against another. It is, of course, patent nonsense to suggest that it is better to have one super-sized PCT covering 782,000 people—by far the biggest in the west midlands—that would then have even less in common as regards health needs. When the consultation is finished, I urge Ministers to reject that sort of reasoning and likewise to reject redrawing the NHS simply for the administrative convenience of the officials concerned.
	Much has been made, without any evidence, of the benefits of coterminosity on our patch—that is, the alignment of the PCT and county social service boundaries. My hon. Friend the Member for Carlisle mentioned the local government White Paper due this summer, which may mean that coterminosity is a transient concept. From my experience, I wish that Staffordshire social services was shaken up to be just as responsive as my local PCT. That is what the county now says that it is going to do by restructuring it to follow our district boundaries. That remains to be done. The county still has to prove that it can get it right. To use that to justify shuffling the NHS furniture into one super-sized option at the same time defies common sense, particularly given that the PCTs in Newcastle and Moorlands already work well together, and with Stoke. They are getting things right, yet follow two discrete district boundaries.
	Other claims have been made for a single PCT, but again without evidence. First, it is said that, by being bigger, it will assist the new practice-based commissioning. There are smaller PCTs in the region and that argument of convenience simply does not hold water. Secondly, it is said that a super-sized option will save on the costs of bureaucracy. That is unproven. The SHA, unable to produce the costings, has recently admitted that the two options would be financially neutral.
	That brings me to my concluding observation about the driving force behind the reorganisation—cost savings. Of course we must direct more resources to the front line—we made a manifesto commitment to save £250 million through "further streamlining"—but we must do it intelligently. It is not good enough simply to shake up SHAs, PCTs and ambulance services and say to each of them, "This is your £X million share of the cost savings to bear." It is not good enough for our regional health authority to say from on high, "This is the only option." Like other Members, my target has been the approach adopted by the SHA. I am grateful for the help that has been given by the Department in the consultation on PCTs. On that basis, I will support the Government tonight, but they must continue to listen and learn from the profound concerns that have been expressed throughout this debate.

Richard Spring: I echo the sentiments that were ably expressed by my hon. Friend the Member for Eddisbury (Mr. O'Brien) in saying that the NHS is of course a patient-centred organisation—he paid tribute, as I do, to the wonderful work that is done by the nurses, doctors and ancillary workers in our hospitals. I myself spent some time working as a porter in West Suffolk hospital, and I saw the professionalism and good humour of those who work magnificently in our NHS. I emphasise that point because people who work so ably and selflessly in the NHS in Suffolk are under massive pressure and subject to great anxiety because of a crisis in funding and an implosion in some of the services.
	Before I became a Member of Parliament in 1992, there was a West Suffolk health authority. We were told that a pan-Suffolk health authority was essential on the grounds of economies of scale, procurement, minimising overlapping and so on. Somehow it was deemed to be the right way to go. A few years ago, we were told that that was all wrong and that we had to have primary care trusts because decisions had to be made more locally and be more attuned to the circumstances of the area. They had to be made closer to the patient.However, a huge error was made. In a county the size of Suffolk, which has a population of only 683,000, no fewer than five PCTs were created, all with expensive chief executives and staff, despite the opposition of Members of Parliament, councillors and health professionals. The Government ignored all their advice. The PCTs were introduced in 2002 and we were told that it would take 18 months to assimilate the reforms. We were supposed to experience the benefits only 18 months afterwards. I say with great regret that there have been few benefits.
	The new proposals go full circle, back to a pan-Suffolk health authority. Goodness knows the amount of taxpayers' money that has been wasted in getting back to the future, but the problem is not organisational. As we know from the consultation process, which has elicited responses from throughout the county, the problem is the operation of the funding formula. The Under-Secretary shakes his head, so I shall spell out the matter clearly.
	After the first change was made in 1998, I went to the then Secretary of State for Health and pointed out its likely effect on rural areas, especially those with an ageing population. Since 2001, no fewer than four changes have taken place. Suffolk West PCT has the third worst audited deficit in the country and is £13.7 million in debt. West Suffolk hospital, the biggest hospital in the area, is running a deficit of £11.3 million this financial year. The total deficit in the county of Suffolk is £35 million. For the strategic health authority area, it is a gargantuan £85 million. That is the heart of the problem and it springs substantially from the change in the formula for NHS per capita spending, which has discriminated against an essentially rural area with an ageing population. No organisational changes in the county will remedy that.
	If the figures sound abstract, I point out that, even in the midst of the consultation process, no fewer than 55 beds have been removed from the West Suffolk hospital in the past few months and 260 staff—15 per cent. of the total—have lost their jobs. Hospitals throughout the county—in Ipswich, Bury St. Edmunds or, indeed, Addenbrookes hospital—are permanently on red or black alert. The position is therefore serious.
	We held a meeting here with the strategic health authority—the body that is charged with overseeing the finances of the PCTs—at the beginning of 2005. There was complete complacency in that meeting. The Members of Parliament present understood what was going on, but the SHA representatives seemed to have no grip of the situation. How could that be? Their function was inexplicable to all of us.
	By June, the SHA had a new chief executive because the previous one resigned, as did the chairman. When its representatives came up to the House of Commons, their attitude was that we Members of Parliament were being somewhat hysterical, and that the problem that concerned us so much did not exist. However, they had changed their tune when we had another meeting last month. There was a sense of desperation in the SHA management, amid concerns that it might not be possible for Suffolk's NHS trusts even to meet their national insurance and tax liabilities.
	As the SHA has overseen the development of such problems, my colleagues on the Front Bench are right that it should be abolished. It has no clear function whatsoever. The SHA's chief executive earns £145,000 a year, and the directors of performance and of service modernisation—what a wonderful euphemism—both earn more than £100,000. Its clinical director gets £150,000 and the chief executive of the work force development confederation £100,000. If those people are being paid such sums to look after three counties, goodness knows what will happen if their responsibilities extend to six. Will they get a proportionate increase in pay? It is no wonder that people feel that the NHS is being undermined by a level of expensive bureaucracy that is not appropriate for its task.
	Suffolk is a rural county, and my constituency of West Suffolk gets £1,156 per capita in health service funding. The Prime Minister's constituency gets £1,576, and the Secretary of State's Leicester, West constituency gets £1,428. The Minister of State's constituency, Doncaster, Central, gets £1,489, while the national average is £1,388. If the county of Suffolk received even the national average, we would not be facing the current crisis. The same is true right across the south and south-east of the country.
	Of course I accept that there have been medical improvements and huge technological advances over the past few years. That has happened continuously since the NHS was created after the war, but the cuts being made are unprecedented. The White Paper mentions various much cherished and valuable community services but they are now under threat, with rehabilitation beds already being closed down.
	The Minister who is to wind up the debate may think that I am exaggerating, but I can tell him that the clergy in and around my constituency have been organising petitions. They are anxious about NHS provision in the area and about the stories that their parishioners tell them. The state of the health service is such that they feel compelled to place petitions about it in their churches and places of worship. The situation is terrible.
	Amalgamation may offer some managerial advantage, but the Government must address the problem of funding and deal with the dead hand of the SHAs by abolishing them. Unless those steps are taken, the NHS will never deliver proper value. That will have consequences for the people in our communities who want the service to work and to succeed, and who are hugely disappointed that it is failing to do so in wide swathes of the country.

Robert Flello: I shall deal in turn with the issues of PCTs, SHAs and the ambulance service, but I want to begin with a few general comments. We in this House agree that we must ensure that NHS funding is used most effectively on the front line, but we must also accept that we cannot preserve the service in aspic.
	At the risk of mixing my metaphors and similes, we might compare the NHS with a supertanker. A vessel that is so big can turn only very slowly, and in the same way change in the NHS must involve many incremental alterations. I shall offer another illustration: if the NHS were a country, the size of its budget means that it would bear comparison with Poland. It is important that we recognise that the NHS needs to change; the question is how those changes are brought about and implemented. We also need quality management and good administrators in the NHS, and we need to value those support staff. Equally, we need to test every pound that goes into the health service to ensure that we get best value for patients.
	The Conservatives devalue some of their arguments by suggesting that everything in the NHS was wonderful before 1997, and that it has all become terrible since then. That is contradicted by the Fenton health centre, which has just been opened in my constituency, and by the Willow Bank surgery, which opened about a year ago in Longton. It is also contradicted by all the additional doctors and nurses that we now have.

Stewart Jackson: Does the hon. Gentleman acknowledge that between 1979 and 1997, there was a 64 per cent. real-terms increase in funding for the NHS, and that £1 million was spent on a capital project in the NHS for every week of every year of that Conservative Government?

Robert Flello: I am grateful to the hon. Gentleman for that interesting intervention. The revenues from North sea oil would have funded a new hospital roughly every week during that time, yet there were no new hospitals built until we came into Government. Constituencies such as mine saw no infrastructure changes of any note in the period that the hon. Gentleman mentioned. My hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) made the point that there has been a 95 per cent. increase in NHS funding in the past few years, thanks to the new investment that is going in. It is disingenuous of the Conservatives to suggest that everything was perfect before 1997 but not since; the opposite is in fact the case.
	There are two primary care trusts in Stoke-on-Trent—North Stoke and South Stoke. They were, de facto, merging; they were working together more closely all the time. To suggest having a single PCT for the whole city therefore makes a lot of sense. It is simply making a reality of what was happening anyway. I pay tribute to the work of my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) on these issues, but there is still a lot of work to be done to ensure that the appropriate options are put in place for the rest of Staffordshire and that they are able to be introduced.
	We need to recognise, however, that the existing system is not the most effective. The Donna Louise Trust, the children's hospice in my constituency about which I have lobbied the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), is a perfect example of primary care trusts not working together collectively. In that instance, a smaller number of PCTs might have the clout to do more.
	That brings me to the subject of strategic health authorities. The system of consultation has not been open or accessible to the people of Staffordshire; it has not been working. The SHA in charge of putting that consultation system together has done a splendid job, if I can put it like that, of obfuscating and making a mess of the whole thing. If that is its role, heaven help us, but I hope that it will have a much more positive one in future. One such role might be in the managing and integration of services, involving not only the PCTs but social services in coterminous areas. The SHA could have a role to play there.

Grant Shapps: Will the hon. Gentleman tell us how expanding a PCT or an SHA to cover a much wider region would make it easier to persuade it to consult and carry out its work properly? Surely that would be a move in the wrong direction.

Robert Flello: No, I think that the opposite is the case. In north Staffordshire at the moment, there are about a dozen primary care trusts going off in all directions. However, a much smaller number would be able to focus much more closely on a hospice such as the Donna Louise Trust, for example, and address its funding in a much more focused way.

Rosie Cooper: Widening SHA areas to a regional authority area would resolve some serious anomalies. In my area of west Lancashire, for instance, PCTs are responsible to the Cumbria and Lancashire SHA, while the hospitals are responsible to the Cheshire and Merseyside SHA, which is an absolute nonsense. The reality is that the challenge for the Government is to make PCTs big enough to be strong commissioners and for there to be a tension in the system, and small enough to be absolutely responsive to the needs of local areas. The size of an organisation should not be easily dismissed.

Robert Flello: I am grateful for that intervention, as it brings me to the point made by the hon. Member for Falmouth and Camborne (Julia Goldsworthy) about the idea that one size is okay as long as it is bigger. That is not what this is about. The issue is not one size; it is what is an appropriate size for merging PCTs. I hope that the consultation, once the SHAs get their paws off it, will be about making sure that PCTs are the right size for the localities concerned.

Julia Goldsworthy: Will the hon. Gentleman therefore list any primary care trusts that will either get smaller or stay the same size under the reconfiguration strategy?

Robert Flello: I would love to have the data to hand to be able to give the answer to that question. The hon. Lady's comment has no doubt been heard by my hon. Friend the Minister.
	I am conscious of the ever-ticking clock. Before I move on to the ambulance service, however, I want to refer to a telling point that was made to me about three years ago by someone who was at that time a manager in the health service, and that relates to my observation about the comments of Opposition Members that everything was rosy up to 1997. That point was that NHS managers had for so many years been used to try to save money, cut budgets and reduce funding, that they did not necessarily have the expertise to apply the huge amount of money that they were suddenly given. I hope that my hon. Friend the Minister will return to that point in her wind-up.
	Many comments have been made about the ambulance service. The hon. Member for Lichfield (Michael Fabricant) and some of my hon. Friends have rehearsed the arguments in relation to Staffordshire very well. A couple of points have not been mentioned. As everyone knows, the M6, which has perhaps more cars on it than any other road in western Europe, gets very congested from time to time, notably on Friday evenings. It only takes a fairly small incident for the motorway to become closed. Frequently, when it is closed or subject to huge delays, some drivers using that motorway are taken ill. One of the things that the Staffordshire ambulance service has been used for in the past—which, as I understand it, it would not be able to do under the proposals—is ferrying off the motorway people who have been taken ill or diabetics who must eat at certain times of the day and suddenly find themselves stuck in traffic for three or four hours and not able to eat. They can be moved off the motorway to a place where they can receive suitable treatment or be treated at the roadside. That is an important role, which shows the innovation and dedication in Staffordshire ambulance service.
	Comments were also made about fast access and survival rates. In certain parts of the country—I will not name them, for fear of upsetting residents of those areas—if someone is taken ill with something like a heart attack, he or she has no chance of survival because the ambulance services there do not bring anybody to hospital alive in such circumstances, whereas in Staffordshire one has a very good chance of survival.

Stewart Jackson: I am listening intently to the hon. Gentleman's eloquent speech expressing his sincerely held beliefs. Does he agree that one of the problems with the mergers is that we have had, in effect, phoney consultations? In my area of the eastern region, under the auspices of the NHS Appointments Commission, a chairman's post was advertised a full nine weeks before the public consultation ends. Does he not agree that that undermines public confidence in the efficacy of such public consultation?

Robert Flello: The clock ticks ever faster, but I am sure that those comments have been heard.
	Today the Staffordshire Sentinel reported that the chief executive of the local ambulance service had suggested that he should form a private company. No doubt that would pose ideological problems for some Members, who would not want a private sector organisation to be funded through the NHS, although it had done such a fantastic job in the past. That would cause some angst to us on the Labour Benches.
	In principle, it is not necessarily a bad idea to merge ambulance services, because in some areas best practice could be shared. What the west midlands does not want is to lose the fantastic service provided in Staffordshire for something that will not be as good. If the reverse were happening and Staffordshire were the dominant area, that would be better.

Richard Taylor: I am grateful to have been called because I feel very deeply about the issue.
	The Government frequently say that they want a patient-led NHS. The consultation document in my area on the mergers of PCTs bears the sub-heading "Ensuring a patient-led NHS". My understanding of that phrase seems rather different from the Government's. It is a glib phrase that sounds good, but to me it really means something: it means that the views of patients and the public are listened to, valued and acted on. Those views should be picked up from a wide variety of sources—independent patient groups, independent patient forums, GP practice participation groups, overview and scrutiny committees and—as the Minister said—health professionals, who have the closest contact with patients.
	To be fair to the Government, they have tried to listen to people. They organised a large listening event in Birmingham—a 1,000-person citizens summit. However, I have seen some of the questions that were submitted to the summit. They were loaded—they expected only the answer that the Government wanted. One question, about the shifting of care, asked
	"To what extent do you support or oppose providing more services closer to home including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?"
	Of course, not many would vote against that proposal, but if people had been given the extra information that in losing those hospitals they would probably lose their local accident and emergency departments, the answer would have been very different.
	If ever there was a top-down proposal, this is it. It is the very antithesis of a patient-led decision. It is the Department of Health leaning on strategic health authorities, which are leaning on the trusts beneath them to do, in effect, the Government's bidding for reasons that are largely financial and—as the Health Committee's report shows—open to very serious question. We should think of the 19 or 20 SHA chief executives and the 200 or so PCT chief executives who are likely to lose their jobs. They are like turkeys planning for Christmas. How can they plan for the future when they know that they are not part of it? How can they be accountable for what they are planning when they are no longer there?
	Incidentally, when those chief executives have left they may well be paid by the taxpayer if past experience is anything to go by. Take the example of Finnamore Management Consultants, who are used, I believe, quite widely by the NHS to address some of the deficits. If we look them up on the web, the vast majority of their staff are ex-NHS managers. Presumably, they were made redundant. They may even have been sacked, or changed jobs for higher salaries.
	I tried to find out a bit more about that firm through a parliamentary question, but I had no luck. The response said that responsibility for financial control belonged to strategic health authorities and denied any knowledge of those consultants. That sort of response annoys me intensely. The Government devolve things when they do not want to answer a question, and impose top-down changes while at the same time talking about devolution.
	I come to my area, west midlands south. I pay tribute to the strategic health authority for carrying out a certain amount of pre-consultation. I regret to say that I responded to that pre-consultation without too many objections because I thought that it was a done deal and that resistance would have little effect. I got into tremendous trouble with some of my friends at home over that passive response. The Health Committee inquiry has brought me round to the other side.
	A lot has been said already about mergers of SHAs. I do not think that SHAs are of the slightest importance. If they go back to being regional health authorities, good luck to them. On local ambulance trusts, as long as I keep my all-singing, all-dancing local computerised control centre, which is as good as any ambulance authority's control centre, I shall be satisfied. As Staffordshire Members have said, if there are mergers, they must lead to a levelling up of services, not a levelling down.
	I object strongly to the merger of the PCTs in my area and I just hope that, with the consultation, local people will really have a chance to make a change. I am not very hopeful because we are being consulted on a preferred option, which sounds the death knell of open, genuine consultation.
	Many hon. Members have examined the main reasons for mergers. The financial argument does not stand up. As I have said, the Health Committee expressed doubt about that. Restructuring involves redundancies and structures to secure local involvement—but those will be incredibly costly. Another argument is that mergers strengthen the commissioning function. That is already happening. The Minister mentioned collaboration, but collaboration is already happening. For a good example, one has to look only at Whitehall & Westminster World, which I am sure we all read. The current edition describes a national decontamination project. It states:
	"Collaborations of up to 8 trusts are now in process and every strategic health authority has signed off a local plan which is consistent with the national plan."
	So collaboration is working already, without the need for mergers.
	I have objections. Many hon. Members have mentioned the number of reforms. I regret to tell them that they have all got their numbers wrong. During the Health Committee foundation trusts inquiry, we received a list of all the reorganisations from 1982 until the date of that inquiry—there were 21. Since that date, there have been at least another seven, so on a conservative estimate there have been at least 28 reorganisations.
	As we have heard, PCTs have only been going three years. They are just beginning to find their feet. Reorganisation affects an organisation badly—we were told on the Health Committee that it can take 18 months to recover from the disruption and another 18 months for the benefits appear. Locally, there are tremendous objections to the merger of three PCTs into one. We believe that we will lose some of the professional input from doctors, nurses and physiotherapists. We believe that we will lose the local public health input and, worst of all, we believe that we will lose the local input from patient forums.
	I believe that it is far, far more important for a PCT in each local area to be coterminous with its district council and its local strategic partnership than for it to be coterminous with a much bigger area. I hope that consultation throughout the country is genuine and that where the status quo is correct, it will remain as an option.
	Edmund Burke said:
	"The people are the masters."
	On 7 May 1997, the Prime Minister said:
	"We are not the masters. The people are the masters. We are the servants of the people . . . . What the electorate gives, the electorate can take away."

Keith Vaz: It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor), who owes his parliamentary career to a successful campaign to defend Kidderminster hospital—which, I understand, is still there. He speaks with great authority on these matters.
	I am sorry that my near neighbour, the Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), is not here today. I understand that she is unwell. I share a hospital with her, I share a city with her, but I did not share the meal with her last night that caused her illness. We would like her to get well soon and come back to Leicester this Friday, for two reasons.
	First, we want to thank her for the huge amount of money that the Government have given to Leicester over the last eight years. There has been an increase of about 98 per cent. in PCT funding, I understand, with three brand new health centres in the city. Two are in my constituency; one in Hamilton and the other soon to start in Charnwood. Secondly, we want to thank her for giving us a PCT that was so responsive to the needs of local people, and I pay tribute to Carolyn Clifton for her excellent work. When I and others have raised issues with her, she has responded swiftly to those concerns and provided us with the services that we need.
	That is why I am so surprised that the Government wish to reorganise the PCTs in Leicester when they are doing so well. We have a particular expertise in our part of the city, where we deal with problems different from those encountered by those who live in the constituency of my right hon. Friend the Secretary of State.
	With things going so well, so much more money being provided and the PCT being so responsive, I am surprised that the Government feel it necessary to merge the two organisations. I am sure there is a justification—I have heard a justification made on the grounds of money—but there is not a justification in terms of responsiveness to the local community. I hope that when the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), replies, he will give more of a justification than saying that it will save £1.5 million a year, or whatever it is. In a budget so vast and ever-increasing, that sounds like a small amount of money, given that we spent much more than that when we set up the PCTs a few years ago. I hope that we will have a response that justifies that decision.
	I am concerned about the abolition of the Eastern Leicester PCT because I am worried about the pathway project, which is central to the rebuilding of the hospital in my constituency, the Leicester general hospital. I have now represented Leicester, East for almost 20 years and I was promised—as were the other right hon. and hon. Members who have represented the city for a generation—that we would have new hospitals as a result of the pathway project.
	I understand that because of the reorganisation, the pathway project in Leicester is now on hold. That means that the investment of £761 million that was to be made in the NHS in Leicester will not now take place. That means that we will not get a new Leicester general hospital, nor the extra cancer facilities that we were promised, nor the new children's hospital, which was to be based in Glenfield, in the constituency of my right hon. Friend the Secretary of State. That is a worry to my constituents and me, because we believe that the Government are absolutely sincere in their commitment to spending money on the NHS and spending it wisely.
	In addition to the pathway project, other hospitals will also be put on hold. I know that a similar decision has been taken at Barts, for example. I was telephoned yesterday by one of the Barts consultants, who is very concerned that the Leicester changes are being linked to what is happening in other parts of the country. So when the Minister responds, I hope that he can reassure me that the proposed reorganisation of Leicester PCTs—I understand the arguments in favour of such reorganisation, but it needs better justification—will not in any way affect the additional money coming in. I know that some of my colleagues do not favour private finance initiatives—they believe that they will somehow prove unhelpful to local people—but I favour them, because I will get a new hospital out of such expenditure.

Anne Milton: I thank the hon. Gentleman for giving way, and I should declare an interest, in that my husband works for a PCT. Does the hon. Gentleman agree that in addition to the reorganisation of PCTs being destabilising, it is ill judged in the extreme, as the Health Committee report said, and patient care will suffer?

Keith Vaz: There are grave concerns about the proposals. I do not know the situation in Guildford and that part of the country, although I was the European parliamentary candidate for Guildford many years ago; indeed, I cycled over the Hog's Back between Guildford and South-West Surrey. I lost that election by 60,000 votes, however, so it is a part of my life that I do not care to remember. The situation in the hon. Lady's constituency may well be as she describes, but my concern is what will happen in Leicester, and how responsive the changes to PCTs will be to the needs of my constituents.

Nicholas Winterton: On PCTs, does the hon. Gentleman not think it very unfortunate that the authorities have put forward a preferred option, which means, in effect, that they are not prepared to consider any other option? That is what happened in east Cheshire, where there is a preferred option of reducing four PCTs to one. In my view there should be two PCTs, in order to recognise the differing cultural needs of east and west Cheshire. Does the hon. Gentleman not support me when I say that a preferred option is not the way to proceed? All options should be equal in the consultation process.

Keith Vaz: I agree that such matters need to be put out to consultation, but as I have not stood as a European parliamentary candidate—or any other candidate, come to that—in that part of the country, I cannot comment on the configuration there. But it must be right for proper consultation to take place.
	That brings me to my final point: the proposed abolition of the ambulance service in my part of the east midlands and the creation of a new east midlands service. The hon. Member for Lichfield (Michael Fabricant), who is no longer in his place, and my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) were right to raise in this House their concerns about ambulance response times, and I have an example similar to the one given by my hon. Friend.
	I attended a funeral at the Gilrose crematorium, which is in the constituency of my right hon. Friend the Secretary of State. One elderly gentleman there was extremely upset, and he became very ill and collapsed. I telephoned the ambulance service and asked it to send an ambulance to take him from the crematorium literally down the road to Glenfield hospital, which is one of the finest hospitals in the country. I offered to take him in my car, but I was asked by the ambulance service operator not to do so unless I was a doctor, which clearly I am not. I said, "I am not a doctor, I am a Member of Parliament, so could you please send the ambulance as quickly as possible." An hour later, the ambulance still had not arrived. Exactly the same circumstances described by my hon. Friend with regard to the London ambulance service applied to the ambulance service in my example.
	Hon. Members may ask why I would want to keep a service that did not respond quickly. Well, I want to keep the service because it is a local service. It is wrong to merge it into such a large area. It is only common sense that the response times will not be as quick as those for a local service.
	My very final point concerns the decision by the local health authority to close the Goodwood ambulance centre in my constituency. It is a brand new centre, near the Leicester general hospital. It houses several ambulances and enables them to get to local people much more quickly. The proposal is to close that ambulance station as part of a merger that will cover the whole of Leicester, with another centre built in another part of the city—or, indeed, of the county.

Robert Flello: Does my hon. Friend accept that one of the successes of the Staffordshire ambulance service is that ambulances have been taken out of the ambulance centres and placed strategically, where they are likely to be needed, at crossroads or theme parks?

Keith Vaz: I accept that point, and that is why I want the centre to stay at Goodwood—near the general hospital and next to a major intersection that links Nottingham to Leicester, and the A46 to the A47, which goes to Peterborough. I cannot understand why it will be removed and why we are merging ambulance services. We are, in a sense, misleading people into believing that the proposals are for consultation, while at the same time advertising the top jobs for the new ambulance service in national newspapers. Like other hon. Members, I have seen such advertisements appear at the same time as we are talking about consulting with local people. I hope that my hon. Friend the Minister will bear that in mind.
	I am a loyal Back Bencher. I am loyal to this Government, who were elected on a Labour party manifesto. I have great affection for, and am a great supporter of, my right hon. Friend the Secretary of State for Health, who will be a great holder of that office, judging by the White Paper that she introduced last week. But even I am tempted not to support the Government on reorganisation, because of the effects that it will have on local people. I ask Ministers to remember what we did to the national health service university. We created a wonderful organisation and then, a few years later, abolished it, leaving a lot of skilled people without jobs and taking away an important concept for educating and training people who work in the NHS. I ask my hon. Friend the Minister to respond to my points and also give me an assurance that further consultation will be held on those issues, and that local people will be listened to in Leicester and throughout the country.

Nadine Dorries: The Minister of State, the right hon. Member for Liverpool, Wavertree (Jane Kennedy) and I both come from the same neck of the woods and I have the greatest respect for her. I have heard her use an expression that is often used in Liverpool: "God loves a trier." Well, the Minister really tried today to sell the merits of the reorganisation of PCTs, but I am afraid that she was not very persuasive to Opposition Members.
	Reorganisation of my local PCT, which is three years old and cowed by debt, would be disastrous. Next month, Bedfordshire Heartlands PCT will be £20 million in debt, and the only way left for it to recover that debt is to restrict emergency services, which is almost a contradiction in terms. When I spoke to the chair and chief executive of the organisation and asked how they intended to restrict emergency services, the answer was frightening. They want GPs to keep patients with them for longer before calling an ambulance to send them to hospital. I asked what would happen if I were a parent with a child with suspected viral meningitis. What should the GP do in such circumstances? The answer was that they would like the GP to make sure that the child really had the illness. Whereas previously, a GP would dial 999 and have the child sent straight to hospital, now the PCT wants the GP to hang on to the patient.
	The proposal caused concern in several areas, not least at Bedford hospital. On Saturday, a consultant from the hospital brought me an e-mail, which I shall happily hand to the Minister once I have removed the top. Bedford hospital is £12 million in debt and its recovery plan to achieve a reduction includes cutting 10 theatre sessions a week, closing two wards and the children's physiotherapy unit, and restricting the use of agency nurses and doctors. The list goes on.
	The e-mail states that unfortunately, there will be a
	"serious financial situation . . . where we will be requiring to make a further all-round cost improvement of 7.1 per cent."
	to achieve
	"a further saving of £2.27 million".
	The cuts to achieve that saving will be a further £530,000 from nursing, a further £375,000 from theatres, a further £1.02 million from medical pay, and a further £200,000 from critical care. Those are all front-line service cuts, in addition to the recovery plan. Only £100,000 of those cuts of £2.27 million will come from administration. The e-mail concludes with the words, "An awesome challenge". It is indeed.
	Members of my PCT do not want reorganisation. The PCT is only three years old and is staggering under its debts. As the Health Committee report noted, reorganisation will cause damage from which it will take 18 months to recover. The move is not advisable, and will do nothing to aid Bedford PCT or Bedford hospital.
	We want to get rid of SHAs, but the Minister asks who would oversee PCTs. May I suggest that she or the Department could do so? SHAs are accountable to nobody and have allowed PCTs to go into debt—by £20 million, in the case of my local PCT. The SHA has no purpose whatever in Bedfordshire. Perhaps if the Minister oversaw PCTs we might have a more efficient service.

Anne Milton: Does my hon. Friend agree that the reforms seem to be less to do with patient care and a patient-centred NHS and far more to do with saving money and getting rid of the debts?

Nadine Dorries: That is highlighted by the cuts detailed in the e-mail; they are all from front-line services and will have a direct impact on patients. Only £100,000-worth of those cuts will be made in administration and back-room services.

Brooks Newmark: May I draw my hon. Friend's attention to the situation in my constituency? For more than 10 years local people have been promised a new community hospital, which is still not forthcoming. Does my hon. Friend agree with many of my constituents that the Government are more obsessed with structures than actually delivering front-line services?

Nadine Dorries: Certainly. Front-line services are paramount. Structures seem to concern the Government, but I ask the Minister to reconsider the reorganisation of PCTs and the damage it would cause to my PCT in Bedfordshire.

Andrew Murrison: I have been in and around the national health service since 1979. It has been a quarter of a century of constant change, much of it for the better, but the near recreation of regional district health authorities and fundholding rebadged as practice-based commissioning is without precedent. While Ministers are absorbed in rearranging the deckchairs, the Opposition prefer to focus on deficits, because they affect our constituents profoundly.
	The Secretary of State for Health may be pleased to dismiss deficits because they represent about 1 per cent. of the NHS budget, but Members of Parliament whose constituencies have PCTs that are in the red know that 1 per cent. means the closure of community hospitals and slamming the brakes on patient services.
	We have heard a total of 11 high-quality Back-Bench contributions this evening. The hon. Member for Falmouth and Camborne (Julia Goldsworthy) said that size matters in relation to trusts and authorities. She is certainly right. The hon. Member for Waveney (Mr. Blizzard) also thought that size was important and made a convincing case against a county-wide PCT. He offered a more functional grouping that would cut across local government boundaries and form what he called the people's PCT. Although I might perhaps bridle at the description, I would certainly endorse hissentiments about functional, not necessarily geographic, linkages.
	My right hon. Friend the Member for Suffolk, Coastal (Mr. Gummer) rightly drew attention to a funding formula that hits rural areas with elderly populations. In his constituency, as in mine, that has led directly to hospital closures.
	The hon. Member for Carlisle (Mr. Martlew) was mildly critical of PCT reorganisation in his area and made a plea for no more reorganisation—a sentiment that was echoed by many right hon. and hon. Members.
	My hon. Friend the Member for Lichfield (Michael Fabricant) emphasised the importance of ambulance response times. I agree that response times should be a crucial determinant in any reorganisation. The hon. Member for Newcastle-under-Lyme (Paul Farrelly) also spoke in support of the independence of the Staffordshire ambulance service. He also supported the thesis of the hon. Member for Waveney in pleading for mergers on a functional, not a geographic or administrative, basis. That thesis is quite correct. The hon. Member for Stoke-on-Trent, South (Mr. Flello) added more support for Staffordshire ambulance service autonomy, based on the so-called golden hour for effective early medical intervention. He also talked about a natural alignment of PCTs in Stoke.
	My hon. Friend the Member for West Suffolk (Mr.   Spring) rightly attacked the waste implicit in constant reorganisation and pointed out that it would not address the financial difficulties of his local health economy one jot.
	The hon. Member for Wyre Forest (Dr. Taylor) quite correctly slated false consultations. People give of their time freely to consultations in the NHS and elsewhere, and I tend to agree with the hon. Gentleman that it does the process no good at all if those views are not taken seriously. I know from my experience of my own area about the damaging effect that sham consultations can have on the debate locally and nationally. We mentioned briefly the consultation in Birmingham, and I suspect that, like me, he has his own views on that process and its results. He also argued for local PCTs that are coterminous with local government boundaries—something that contrasted with some earlier contributions.
	The hon. Member for Leicester, East (Keith Vaz) was worried about the abolition of his local PCT and the non-appearance of a new general hospital in Leicester—that, of course, involves a £574 million PFI scheme.
	My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) finished by highlighting service cuts that result from the financial recovery plan in her PCT. She feared that PCT reorganisation would set things back 18 months. I would tend to share some of her concerns.
	In redesigning services, structure must follow function—not the other way round—but it is not yet clear what PCTs will be responsible for. As for SHAs, many of us are mystified by their current role, let alone what Ministers intend for them in the future. At the moment, the SHAs' ability to be strategic—whatever that means—must be constrained by their preoccupation in areas such as mine with financial deficits. Of course, there will be some benefits to all of this: the perpetual merging, axing and reforming of health bodies is a fantastic way to blur accountability. People who have tried to identify those who should be held to account for deficits know that very well.
	We have a number of questions, some of which have been fielded already in today's debate, and we would like the Minister to answer them. First, we would like to know what the Minister intends that PCTs will be doing in the future because that is far from clear. What will be the residual provider function of PCTs? In the summer, "Commissioning a patient-led NHS" said:
	"the direction of travel is clear: PCTs will become patient-led and commissioning-led organisations with their role in provision reduced to a minimum."
	However, the Secretary of State, Sir Nigel Crisp and Mr. John Bacon then issued contradictory interpretations of what that meant. The confusion has caused real discomfort to NHS staff who are employed directly by primary care trusts. Furthermore, it has made a complete mockery of the restructuring exercise. How can an organisation possibly be restructured if the people at the top do not have the first idea what that organisation will be doing? If Ministers want to use the private sector more—they say that they do—what message do they think that the vacillation will send to non-NHS providers that are possible partners? It will suggest unreliability.
	Ministers might say that PCTs will be commissioning care, but how will they do so when patients are free to choose and book? I have to say that under our proposals, they would be even freer to choose the treatment that they receive and where it is received. If PCTs are largely divested of provider and commissioning functions, will they not simply become GPs' account clerks? If so, will they be further reconfigured to reflect a new vestigial role? If that is not the case, how will we manage the split between providers and commissioners in the new organisations? It seems to me that Ministers are extremely unclear about that point, so any clarity that the Minister can give us today would be most welcome.
	The Prime Minister apparently often regrets not being bolder, which is when we understand that he is at his best. How does that fit with practice-based commissioning? Does the Prime Minister in fact know full well that abolishing fundholding was foolish and recognise that practice-based commissioning is the closest approximation that he will get without primary legislation and the embarrassment of a complete about turn?
	The Government's interpretation of the dubious consultation exercise "Your health, your care, your say" was different from mine and that of several hon. Members who contributed to the debate and people elsewhere. Will the Minister admit the extent to which the consultation was bent to the purpose that had already been devised by his colleagues and confirm specifically that his vision of contestability was largely shunned by the consultees who were selected to give their views? I offer no defence or otherwise of contestability, but it is important that we reflect accurately and sincerely views expressed during the course of consultation exercises. It seems to me that that has not been done in this and other areas. My point obviously relates directly to the consultation in Birmingham, so I would be grateful if the Minister would shed some light on what those who responded in Birmingham thought about contestability.
	Where does the Minister think that public health function will reside in the new scheme of things? Those   of   us who take an interest will have witnessed directors of public health being sidelined in PCTs that are largely focused—often unsuccessfully—on financial management. Could it be that the manifest failure to communicate the recent change in policy on BCG vaccination, for example, is symptomatic of the malaise in public health in recent years? The Faculty of Public Health's latest work force survey reveals that more than 100 senior public health posts have already been lost in the past three years. It estimates that the latest reorganisation could lead to the loss of a further 120 posts. I hope that the Minister agrees that that would be grossly unsatisfactory. It would be useful to hear from him how the set of reorganisations will enhance public health function, rather than damage it further.
	Will the restructure achieve the Government's intended saving of £250 million, or will it, like most of its type, end up sapping resources from front-line services? If trusts make savings through reorganisation, for example in the merged Avon, Gloucestershire and Wilshire ambulance trust, will the Minister confirm that they will go towards improving front-line services in the trust, rather than being siphoned off to address financial deficits at the strategic level?
	In summary, the structure of the NHS is pretty well back to where it was in 1997, when we left it. It would be churlish if I sat down without acknowledging the compliment.

Liam Byrne: Our debate this evening has been very good if, in places, a little less consensual than the debate earlier this afternoon.
	In some ways, this debate underlines how far the health service has moved under this Government. When we were elected in 1997, the public's priority, and therefore ours, was to lift the NHS off its knees and rebuild the services that had been ground down over 18 years under the Conservative party. We had to end the inequity of GP fundholding, under which some patients could jump to the top of the queue without rhyme or reason. In particular, we had to rescue our hospitals because, of course, some one in 10 people were languishing, waiting for an operation for two years or more.
	The situation today is somewhat different: 100,000 extra staff, the biggest hospital-building programme ever and, as a result, the shortest waiting lists since records began. Indeed, on 31 December 2005, just 12 patients had been waiting over six months for care. The result, of course, is that people are now living longer. The death rate from circulatory heart disease is down 31 per cent., and the death rate from cancer is down 12 per cent. That benefit is especially felt by older people; life expectancy in the over-65s is rising and the level of vaccinations among those over 65 is at an all-time high. Delayed discharges are down by two thirds, and 1.7 million bed days have been saved through the changes that this Government have introduced.
	Now, having stabilised the NHS, the question facing us is how we move forward. Not only have we introduced new choices of hospitals, but last week we laid before the House our White Paper, which is important because it signals a new direction of travel for the NHS, with greater personal care, greater access to primary care services, a shift of resources into prevention, which I think Conservative Front-Bench Members decided to welcome, and a far better relationship between the NHS and local government.
	If the NHS can deliver on that agenda, there is a great prize here to be won—great inroads into health inequalities. Over the past seven years we have made great strides in creating far more opportunity in this country, so surely our challenge now, after the longest record of economic growth and after putting more people into work than ever before, is to make sure that everybody, in every community, has the health and well-being to seize those new chances. That is exactly why we have to update PCTs and ambulance trusts, not because of the damaged legacy that we inherited in 1997, but for the opportunities of 2006.

Andrew Lansley: Will the hon. Gentleman give way?

Liam Byrne: I know that the Conservative party is firmly fixed in listening mode at the moment, so if the hon. Gentleman will forgive me, I plan for him to listen just a little longer.
	My hon. Friend the Member for Leicester, East (Keith Vaz) asked why we have to change—why we have to adapt. Governments have been talking about the need for a shift in the balance of primary care since the 1920s. In 1976, Baroness Castle set out in "Priorities for Health and Social Services" her ambition to move care into the community. The truth is that over the next four years and the subsequent 18 years of Conservative Administrations, we did not achieve that shift in the balance of care. This time, we have to make sure that the shift takes place. I am happy to give my hon. Friend an assurance that the new fair funding that we have introduced will stay in the places to which it has been awarded.
	We have to make sure that, where appropriate, PCTs are coterminous with local authorities. We have to make sure that they are strong enough to hold GPs to account. We have to make sure that they can connect effectively with local communities because that is the only way that they will deliver on the ambitions that we set out in the White Paper.

Julia Goldsworthy: Will the Minister give way?

Liam Byrne: I shall address the hon. Lady's remarks directly in a moment, if she will have a little patience.
	My hon. Friend the Member for Waveney (Mr. Blizzard) put a powerful case for one of the two options in his local consultation, saying that it was the healthy option, the people's PCT. I am sure that what he said was heard clearly by those local health professionals managing the consultation. I am happy to give him an assurance that there is no template.
	My hon. Friend's near neighbour, the right hon. Member for Suffolk, Coastal (Mr. Gummer), did himself no favours by quoting answers to named day questions. Frankly, it was shameful of him not to recognise the advances that have been made in his local NHS. It is not worse than 30 years ago, and it is an insult to the performance of NHS staff in his area to pretend that waiting lists and death rates have not come down thanks to the new funding that we have put in, which I might add he voted against—I think—not on one occasion but on four occasions over the past three years.
	The hon. Member for West Suffolk (Mr. Spring) added that he was frustrated with the way that funding was not geared to areas of need, but that is exactly what the new funding formula has done. He knows full well that £73 million extra is going to his PCT over the next few years. He has the opportunity over the next few years to distinguish himself by having a conversation with the right hon. Member for Charnwood (Mr.   Dorrell), who is chairing the policy review on health.

Richard Spring: rose—

Liam Byrne: The hon. Gentleman has the opportunity to say that his party's fiscal rule that the proceeds of economic growth should be shared between public service investment and tax cuts should not apply to the health service, and he should ensure that the right hon. Gentleman comes out with a clear commitment to match our levels of investment.

Richard Spring: rose—

Hon. Members: Give way.

Liam Byrne: Turning to—[Interruption.]

Mr. Speaker: Order. I must be allowed to hear the Minister. I have to hear what he is going to say.

Liam Byrne: Turning to the west midlands, the hon. Member for Lichfield (Michael Fabricant) made a powerful and persuasive case in which he underlined and celebrated the achievements of Staffordshire ambulance service. It is indeed an ambulance service from which many in the country could learn. He was, perhaps, over-hasty in writing off the performance of the rest of the west midlands, but there is a clear message that we should take from his remarks, and it was underlined by my hon. Friends the Members for Newcastle-under-Lyme (Paul Farrelly) and for Stoke-on-Trent, South (Mr. Flello): there must be localisation of control. Surely the question in this consultation, though, is how we export that excellence, not just to other parts of the west midlands but to other parts of the country, and how we ensure that Staffordshire gets better in future. Surely it has not reached its full potential.
	My hon. Friend the Member for Carlisle (Mr. Martlew) was dissatisfied with current arrangements and welcomed a change. I know that his input into consultation arrangements will be well informed by his previous experience.
	The hon. Member for Wyre Forest (Dr. Taylor) had a great deal to say about consultation. I was heavily involved in consultation on the White Paper. I would recommend it to Members in all parts of the House. There could well be more listening to be done on health policy.
	I listened very hard to the hon. Member for Falmouth and Camborne (Julia Goldsworthy). I was trying to detect any hint of what Liberal Democrat health policy might be. I know that the right hon. Member for Ross, Skye and Lochaber (Mr. Kennedy) instigated a sweeping policy review not long ago, saying that he would approach it with a blank sheet. That blank sheet, it seems, is his legacy, and from tonight's debate we can deduce that it will withstand the test of time. I can think, therefore, of no better quote than that of the former vice-chair and chair of the Hodge Hill Liberal Democrat party, who led a mass defection to Labour on Saturday night. He said that there is a lack of leadership not just in Westminster but in local communities. I think that I can see what he meant.

Julia Goldsworthy: Will the hon. Gentleman give way?

Liam Byrne: No, I must address the remarks made by Conservative Members.
	We did not hear too much—

Julia Goldsworthy: Will the hon. Gentleman give way?

Liam Byrne: No, I will not give way, because I have a bit more to finish.
	We did not hear too much about the Conservative alternative. It remains a bit of a mystery, wrapped in an enigma, wrapped in a taskforce, although the alternative for health benefits from quite sensible leadership. We were not expecting an apology for voting against the National Insurance Contributions Act 2002 or against the Finance Acts of 2002, 2003 or 2004, but I thought that we might have heard a little clarification about the new fiscal rule of the right hon. Member for Witney (Mr. Cameron). Are the fruits of growth to be shared with tax cuts, or—

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—
	The House divided: Ayes 216, Noes 291.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order 31 (Questions on amendments), and agreed to.
	Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House welcomes the Government's determination to reform primary care trusts (PCTs) and strategic health authorities (SHAs) to ensure all patients get the services they need, to shift the focus of services more towards prevention and tackling health inequalities, to engage better with GPs in developing services that meet patients' needs, to reduce bureaucracy and to deliver better value for money for taxpayers; further welcomes the widespread support within PCTs and SHAs for the principles on which Commissioning a Patient-Led NHS has been based; and further welcomes the Government's consultation on reforming ambulance trusts to ensure more care is provided in the home and at the scene, to give better advice to patients over the telephone and to deliver faster response times to save more lives, in line with the recommendations from the National Ambulance Adviser Peter Bradley's review "Taking Healthcare to the Patient: Transforming Ambulance Services".

DELEGATED LEGISLATION

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Intellectual Property

That the draft Artist's Resale Right Regulations 2006, which were laid before this House on 15th December, be approved.—[Joan Ryan.]

Mr. Speaker: I think the Ayes have it.

Hon. Members: No.
	Division deferred till Wednesday 8 February, pursuant to Standing Order No. 41A (Deferred divisions).

National Lottery

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
	That the draft National Endowment for Science, Technology and the Arts (Increase of Endowment) Order 2006, which was laid before this House on 9th January, be approved.—[Joan Ryan.]
	Question agreed to.

PETITIONS
	 — 
	Staffordshire Ambulance Service

William Cash: I rise to present the petition of thousands of concerned Staffordshire residents and patients, which declares:
	That the Government's plans to merge and centralise the Staffordshire ambulance service will lead to a poorer service, undermine morale and increase costs. The petitioners therefore request that the House of Commons opposes the planned merger of the Staffordshire Ambulance Service into a regional West Midlands Service.
	And the Petitioners Remain.
	To lie upon the Table.

Student Debt

David Taylor: Five days ago, in business questions, I flagged up the parlous state of many students of nursing and midwifery, and I am here tonight to present a petition that has been compiled by my constituent, trainee midwife Andrea Simpson of 20, The Green, Donington le Heath, Coalville. The petition states:
	To the House of Commons: the petition of 2,947 residents of north-west Leicestershire and other areas declares that there is a persistent and growing problem of student debt, particularly among those training in nursing and midwifery, as evidenced by a Royal College of Midwives survey showing that over 20 per cent. of such students, many of them more mature ones, do not complete their studies due to financial hardship.
	The petition notes that student midwives are sometimes taking out overdraft facilities, remortgaging their homes, cashing in endowment policies and buying food on credit cards in attempts to make ends meet.
	The petition regrets that trainees for these key health professions are in such difficulty.
	The petitioners therefore request that the House of Commons urge the Secretary of State for Health to work with the Chancellor of the Exchequer to examine the possibility of ensuring that all NHS Students of Nursing and Midwifery receive a non-means-tested bursary of £10,000 per year for their course, to enable them to train for their chosen career.
	And the petitioners remain.
	To lie upon the Table.

NETWORK RAIL (SUTTON COLDFIELD)

Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]

Andrew Mitchell: I am delighted to have secured this Adjournment debate regarding the behaviour of Network Rail towards my constituents in Sutton Coldfield. I have been in extensive correspondence with Network Rail and its chief executive, John Armitt, since 13 October 2004 regarding a line of grey stainless steel fencing that has been erected along a section of the freight line at East View road in my constituency. That fencing is ugly, does not fit in and is an eyesore.
	This is a story of arrogance and insensitivity, but, above all, of a complete lack of corporate accountability. East View road is a residential area in the green belt, located next to the picturesque New Hall Valley country park. It is an environmentally sensitive area and, although my constituents accept that they live next to a freight line and that line security is important, they do not accept the kilometre of monstrous, ugly grey steel fencing that has been erected. They want it to be replaced by green powdered fencing, which would be more suitable for the area. Network Rail has been asked to replace the grey fencing that it erected with more appropriate green fencing, but it has refused point blank.
	My constituents have been pursuing this point with Network Rail since March 2004 and I took up their case in October of that year. We have since been in frequent correspondence, and held a series of site visits and meetings—all to no avail. Network Rail has never truly engaged with the complaint or displayed any signs of sympathy towards the case. The arrogance and lack of interest that my constituents' complaint has received has been truly insulting. We can only conclude that Network Rail, although it states that it has an interest in being a responsible neighbour, has no intention of being anything of the sort. I therefore have no alternative but to highlight this sorry case to the House tonight. Network Rail has, through its behaviour, clearly demonstrated that its publicly stated environment policy and improved customer relations objectives are nothing more than box-ticking exercises. They hold no currency in the day-to-day business of Network Rail.
	In its stated key objectives, Network Rail claims that consultation with community groups, Government agencies and local authorities
	"is essential to our success."
	It continues:
	"We are rebuilding trust in the nation's rail network by listening to our customers."
	Network Rail's published environment policy, which was signed by John Armitt, the chief executive, in March 2003, claims to offer environmental safeguards. Its stated vision is to "achieve environmental excellence" by engaging in dialogue with stakeholders and to seek continual improvement in its environmental performance. The company claims:
	"We are committed to developing our relationships with the community and strive to be good neighbours across the areas in which we operate."
	There is no evidence whatever of that in the case of East View road.
	John Armitt is coming to the House next Monday to hold an MPs' "surgery" over line-side issues. I am sure that he is coming with every intention of promoting Network Rail's neighbourly credentials. However, if he did not feel that it was worth accepting my invitation to visit the East View road site and was unable to use his authority to address my constituents' problems, why should we think that that surgery is anything other than just another tick-box exercise, a cynical stunt straight from a public relations textbook?
	When one of Mr. Armitt's staff came to meet my constituents, after many requests, he was reduced to an embarrassed silence and was unable to defend the actions and attitudes of Network Rail in any way. He promised to go back to Network Rail to try to ensure that a fair and equitable solution was agreed. Nothing of the sort occurred. The subsequent letter that I and my constituents received was a muddle of smug, complacent bureaucracy that addressed none of my constituents' arguments.
	The views of the residents of East View road are being swept aside by the over-mighty Network Rail and their line-side issues simply ignored. Network Rail did not engage in any dialogue prior to the erection of the stainless steel fence, either with the local residents or the city of Birmingham planning office. The residents' first knowledge of Network Rail's plans to construct the fence was when they awoke to the sound of workmen cutting back trees, removing bushes and digging up the undergrowth before hastily putting up the fence. The residents of East View road only received correspondence from Network Rail after they had vociferously complained. A request for a temporary halt for a meeting to discuss the issue was rejected out of hand.
	Despite representations made by my constituents, Birmingham city council planning office and me to request the use of green fencing, it has refused in a most uncompromising, unsympathetic and offhand manner. The current grey fencing is acknowledged to be environmentally insensitive and completely inappropriate for areas in or around the green belt. At other locations in Sutton Coldfield, more suitable fencing of the green powder-coated variety is used. The question from my constituents is: why cannot they be treated the same as others and have appropriate fencing?
	Frustratingly, my constituents and I have no recourse to pursue Network Rail for breach of the local authority planning regulations, as Network Rail does not come under its jurisdiction. Birmingham city council planning control office confirmed on 22 June 2004 that the Town and Country Planning (General Permitted Development) Order 1995 allows Network Rail to carry out permitted work on its land without planning permission. Fencing does not therefore require planning permission, and Birmingham city council, whatever its view, has no power to intervene.
	Had the residents tried to put up such a fence, Birmingham city council would have insisted, due to the environmentally sensitive nature of East View road, as made absolutely clear by the city's planning policy, that the fencing must be green. There are innumerable examples of Birmingham city council having erected the sort of green powder-coated fencing that my constituents are seeking. For example, at the nearby Bishop Walsh school, which is also adjacent to the railway line and New Hall Valley park. The city council granted planning approval subject to the condition that the fencing would be powder-coated green. The reason for that condition is to
	"safeguard the visual amenity of the area".
	As a result all security fencing fronting the highway in this locality is coloured green.
	The Walmley local action plan of May 2002, produced by Birmingham city council's planning department, declares:
	"the area does contain an historical legacy that is probably unique in the city. This centres on New Hall Valley and its listed buildings which represent a microcosm of a centuries old rural landscape and way of life".
	It also proclaims
	"This strategy is grounded in the widely accepted belief that the quality of the environment is of fundamental importance to the quality of life for local residents."
	Furthermore—this is highlighted in capital letters in the action plan:
	"Any Development proposed within the green belt will be strictly controlled to protect the character of the area and will only be approved if in line with the city council's more detailed guidance for green belts set out in the Birmingham plan."
	The plan identifies the area around the railway track as a wildlife corridor, and says that as such it requires careful consideration.
	According to the Walmley plan, any security fencing that is erected should be green, and whoever at Network Rail made the decision to use galvanised steel fencing had no regard for the local neighbourhood or for its own environmental policy. Birmingham city council did try to seek a voluntary solution, without success, finding Network Rail
	"to be unhelpful and unsympathetic".
	Network Rail has made a gross error of judgment in not treating the location with sensitivity and respect, and in not rectifying the clear errors that it made at the outset. It has been unable to give my constituents its reasons for not installing a green fence, despite having installed green fencing in other locations around Sutton Coldfield, including Mulroy road and Four Oaks station. Network Rail says that
	"the type and finish of the fencing was correctly assessed prior to its erection and given this it will remain".
	It has refused to give details of how the assessment was made.
	In August 2004, Network Rail suggested a compromise—that the residents paint the fence green themselves. Network Rail agreed to provide the paint, but the offer was later withdrawn on health and safety grounds. My constituents sought to use the Freedom of Information Act 2000 to obtain more information about Network Rail's green fencing policy, only to find that Network Rail was not classified as a qualifying body under the Act. However, the rail regulator—the Office of Rail Regulation, as a qualifying body—offered to try to obtain the information on behalf of my constituents.
	The ORR was told by Network Rail that it was under no obligation to release any information under the Act, and it therefore arrogantly refused to release any information relating to my constituents' request. My   constituents asked the ORR whether it could forceNetwork Rail to install green fencing in environmentally sensitive locations. The ORR explained that while it was sympathetic to the cause, it only set the contractual and financial framework within which Network Rail operates and was not involved in the details.
	This is a very difficult situation for my constituents. The residents of East View road have the impression that Network Rail is an uncaring, unaccountable and faceless organisation that can exercise its powers without challenge and in an arbitrary way, while ignoring any local resistance to its actions. The ORR has no direct control over Network Rail; it only provides a framework. The local planning authority has no powers, as Network Rail has permitted development rights. My constituents are unable to refer the matter to any third party for a review. They cannot refer it to an ombudsman, to an appeal body or to a judicial review. As for the Network Rail environment policy, it is policed by Network Rail itself and cannot be challenged. The key objective of improved customer relations set out by Network Rail has also been ignored. Network Rail has simply not listened to its stakeholders.
	It that context it adds insult to injury for my constituents that John Armitt, chief executive of Network Rail, received a salary of three quarters of a million pounds in 2005—£754,757, to be precise. If it goes up any more, we shall soon be talking serious money. His bonus was presumably not linked to the company's environmental policy targets.
	It is my strong contention, having regard to the sensitivity of the location, and in line with Network Rail's fencing policy in Mulroy road, Wylde Green road, Station approach, Bowlas avenue and Lichfield road close to Four Oaks railway station, that the fencing in East View road should be fully replaced with green powder coated fencing. However, I acknowledge that there are significant cost implications. I want to be helpful, constructive and suggest a compromise solution. Instead of removing the whole fence and the posts supporting it, which is where much of the expense would arise, it should be perfectly feasible to remove just the panels themselves, which are simply bolted on, and it would take just minutes to remove each one. The original support posts could remain and new green powder coated panels bolted on. The existing silver grey fencing could be reused elsewhere, although only where appropriate and not in an environmentally sensitive area such as this.
	Network Rail should put an end to the sorry situation and work with the community in East View road, respecting their environment and their opinions to find an acceptable solution. No MP would stand for such arrogant treatment of their constituents, which is why I bought the case to the House.
	We look to the Minister, who has in the past shown sensitivity on these issues, to call in the chief executive, to remonstrate with him over the way in which my constituents have been treated, to remind him and Network Rail of their environmental obligations—not least those obligations set out by Network Rail itself—and to make it clear that, as the Minister responsible for Network Rail, he does not expect to see that high-handed and arrogant behaviour replicated anywhere else.

Derek Twigg: I congratulate the hon. Member for Sutton Coldfield (Mr. Mitchell) on securing the debate. It is clear from his remarks that this is a matter of ongoing concern in his constituency. I thank him for the information that he provided before the debate, which has been helpful in preparing the response to the important matter that he has raised.
	Before dealing with the specific issue, I would like to say a few general words about Network Rail and its structure, objectives, responsibilities and priorities. Network Rail is a very large organisation and has a diverse and extensive portfolio of land and property. It employs more than 30,000 staff and owns and maintains 21,000 miles of track. Network Rail's priorities must be focused on the effective management of the rail network. Its first priority is to operate a safe, reliable and affordable railway.
	The hon. Gentleman is concerned that Network Rail is not accountable to Ministers and that it is unclear to whom it is accountable. In truth, Network Rail has a large number of stakeholders, and I will say more about that shortly.
	The concerns in Sutton Coldfield arise from the installation of new line-side fencing. The main reason for that is to improve safety and to prevent trespass on the railway. The primary responsibility for preventing trespass on the national rail network lies with Network Rail. In doing that, Network Rail works closely with the British Transport police, the Department for Transport and others in the rail industry and the wider community.
	Network Rail's national fencing programme is designed to reduce the scope for unlawful access to the rail network, and is recognised as a good initiative. I note that neither the hon. Gentleman nor his constituents dispute the need for fencing along East View road.
	The hon. Gentleman raises concerns about Network Rail's lack of accountability to local planning authorities, in particular with regard to planning policies about the colour of fencing. As a statutory undertaker, Network Rail enjoys permitted development rights, under part 17 of the Town and Country Planning (General Permitted Development) Order 1995, for development on its operational land required in connection with the movement of traffic by rail. Statutory undertakers have acquired such rights for very good reasons. They provide an essential service to the public. It would therefore be unreasonable and inefficient to require them to make a planning application for essential development each time they needed to build something on their operational land.
	The Office of the Deputy Prime Minister is carrying out a review of the permitted development order arising from its 2002 Green Paper outlining proposals for fundamental reform of the planning system. The review included a research study of the permitted development rights available to railway undertakers. Following publication of the study in September 2003, ODPM will undertake a public consultation before implementing any proposed changes to current rights.
	I would like to go into more detail about Network Rail's status and responsibilities. Network Rail is a private sector company operating on a commercial basis. It is a "company limited by guarantee". It has no shareholders and so does not have to earn dividends to pay them. Instead, any surplus it makes can be reinvested in the rail network for the benefit of all.
	I think that at this point it would be worth explaining the new railway structure following the Railways Act 2005. The changes are vital to drive up standards, improve overall performance and underline who is best placed to deliver. The Government have taken charge of setting the strategic direction of the railways. In future, the Government will decide the high-level outputs they wish to buy from the railway and the public sector funding available for this.
	Network Rail has been given clear responsibility for operating the network, and for its performance, timetabling and route utilisation. Train and track companies are working more closely together through the introduction of joint control rooms. The Office of the Rail Regulation now covers safety, performance and economic regulation. As part of being a company limited by guarantee, Network Rail's board is accountable to its 100-plus members. These are drawn from the industry and wider rail stakeholders including local and regional bodies, passenger groups as well as individuals. The Department for Transport is also a member.
	Network Rail's members hold the board to account as shareholders would do in a PLC, although of course they have no financial interest in Network Rail. They appoint and reappoint directors, approve directors' remuneration and agree the company's annual report and accounts, but they do not get involved in the running of the company. Network Rail's priorities inevitably must be focused on the effective management of the rail network. Its first priority is to operate a safe, reliable and affordable railway and securing the network plays an important part in achieving this goal. However, Network Rail must also strike a balance between operating a safe and reliable railway and addressing environmental and community concerns.
	Network Rail is accountable to its regulator, the Office of Rail Regulation. The ORR ensures that Network Rail sticks to the terms of its licence in running the network. If it thinks it is not doing a good enough job, it can take—or consider taking—enforcement action against Network Rail. The ORR also sets the income that Network Rail should receive and the outputs it must deliver for that income. Network Rail is also accountable to its major funders—the Secretary of State and, from April this year, Scottish Ministers. It must be for Ministers, who are accountable to Parliament, to set the national strategy for the railways. Under the new arrangements implemented by the Railways Act 2005, the Government will set the level of public expenditure and take the strategic decisions on what this should buy.
	Network Rail is accountable to its local communities. The company owns 21,000 miles of track. That is a lot of neighbours, including, of course, those in the hon. Gentleman's constituency. Despite the problems in his constituency, I welcome Network Rail's ongoing engagement with wider communities and its initiatives against railway trespass; for example its innovative "No messin!" campaign last summer to warn youngsters of the dangers of "playing" on the network, and targeted at route crime hotspots.
	I am glad to see that the chief executive of Network Rail is actively engaging with hon. Members through the planned line-side surgeries. I understand the concerns that the hon. Gentleman has raised, but it is a good initiative. I also believe that Network Rail is concerned about the local environment.
	The hon. Gentleman raised concerns as to whether Network Rail's responsibilities to its neighbours fell short of what was expected in this instance. I very much hope the concerns of his constituents about the type and finish of the fencing can be resolved to everyone's satisfaction. But subject to Network Rail complying with the terms of its licence and relevant statutory requirements, we have no powers to intervene in operational decisions. Except in a limited range of circumstances related to security or major emergencies, Ministers have no powers to issue directions or any other binding instructions to Network Rail.
	I shall certainly bring the concerns that the hon. Gentleman has raised, and his compromise proposal, to Network Rail's attention and ask it to respond directly to him.
	Question put and agreed to.
	Adjourned accordingly at sixteen minutes to Eleven o'clock.